? Lantus SLGL questions-Should I have skipped AMPS shot & should I continue @ 1.75?

[leeza]

I'm still figuring this out and don't think I'm doing a very good job for Kuro! This morning, his BP at 9:30am was 128, which is the lowest it's been since January. Reviewing the info on SLGS I followed the following protocol:
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. - Followed this, but wondering if I should have done the following instead:

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 between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose - Should I have done this, or is this just when I'm doing a curve at the 7-day mark? OMG, which I see I should have done today....

His readings throughout the morning were as follows: No shot at 9:30am, 365 @ +2.0; 490 @ +8.25, and 559 +10.5
Just gave him 1.75 units at 8pm (+10.5), since he didn't have a shot this morning. Thinking this is okay since he didn't have an am shot, even though it's before his 12 hr mark.
I only work a couple of blocks from home so I can easily take a break & come home to test/give him a shot at any time.
My questions are, should I have actually skipped his shot in the morning? And, should I continue at the 1.75 dose for another week to get better info?

 

[Wendy&Neko]

Here's the link to your previous post here, which we like to see for continuity: Stuggling w/ Lantus SLGS - increased dose after 7 days, but numbers are going up

If you read further on the section on lower preshots in the SLGS dosing method, you'll see the following:

With experience, you may find that lowering these thresholds may work well for your cat. When you have reached that stage, the following guidelines are suggested for Lantus, Levemir, and Biosimilars users following the Start Low Go Slow approach:

If the preshot number is far below usual preshot numbers:

• Do you need to stay on schedule? Then skip the shot.
• Do you have some flexibility with your schedule? Then stalling to wait for the number to rise might be a good option. Don't feed, retest after 30-60 minutes, and decide if the number is shootable.
• Repeat until the cat either reaches a number at which you are comfortable shooting, or enough time has passed that skipping the shot is necessary.

If the preshot number is near kitty's usual preshot numbers:

Look at your data to see what numbers you have shot in the past and decide what would be a safe, shootable number for your cat. Don't feed. Stall until kitty reaches the preshot number you've decided on and then shoot.
We usually don't suggest or recommend shooting a preshot number less than 90 mg/dL when following the SLGS Method. Remember that with SLGS, generally speaking, your goal is to achieve flat numbers that are greater than 90 mg/dL. However, let experience, data collected, knowledge of your cat, and availability to monitor help in making the best decisions for your cat.

Summary, over time and with data, you can reduce the "no shot" number. Eventually even down to 90. But you aren't there yet. Another technique you can try next time is to stall 20-30 minutes and see if he is going up to a number you feel comfortable shooting. You can still stay on schedule if you shoot 1/2 hour late.

Shooting early this PM was fine, you want to make sure shots are at least 12ish hours apart and it was that.

If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose - Should I have done this, or is this just when I'm doing a curve at the 7-day mark? OMG, which I see I should have done today.

You have to do one curve in the 7 days you hold the dose, it doesn't have to be the 7th day. It can be a couple days earlier if that works better for your schedule. If you don't shoot, then doing a curve doesn't make sense. Similarly, try to avoid a cycle where he's bouncing as the curve then won't tell you much. The "if nadirs are between 90 and 149" part refers to nadirs (note the plural) and any time you test during the 7 days.

You do want to stay on this dose and gather more data to answer the question "how low is this dose taking my cat?". More spot checks during not curve cycles can help you do that. With a PMPS of 8:30, can you get a 10:30 test before bed? Many cats go lower at night and it'd be useful to get those before bed tests to find out what is happening then. The skip has also depleted the depot, so you'll likely need at least 3 more days on this dose.

 

[hellen_maggie]

I'm still figuring this out and don't think I'm doing a very good job for Kuro! This morning, his BP at 9:30am was 128, which is the lowest it's been since January. Reviewing the info on SLGS I followed the following protocol:
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. - Followed this, but wondering if I should have done the following instead:

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 between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose - Should I have done this, or is this just when I'm doing a curve at the 7-day mark? OMG, which I see I should have done today....

His readings throughout the morning were as follows: No shot at 9:30am, 365 @ +2.0; 490 @ +8.25, and 559 +10.5
Just gave him 1.75 units at 8pm (+10.5), since he didn't have a shot this morning. Thinking this is okay since he didn't have an am shot, even though it's before his 12 hr mark.
I only work a couple of blocks from home so I can easily take a break & come home to test/give him a shot at any time.
My questions are, should I have actually skipped his shot in the morning? And, should I continue at the 1.75 dose for another week to get better info?

Hi Lisa,
I had very similar questions and fears in my post yesterday.
? - 23/02, Maggie, AMPS 345 / +3 223 / +5 124 / +6 126 / +8 151 / +10 187

The advice and support I received really helped me see things more clearly and feel more confident.
I hope reading through it helps you too, the way it helped me. We’re all learning, and we’re not alone in this.

 

[leeza]

Here's the link to your previous post here, which we like to see for continuity: Stuggling w/ Lantus SLGS - increased dose after 7 days, but numbers are going up

If you read further on the section on lower preshots in the SLGS dosing method, you'll see the following:

Summary, over time and with data, you can reduce the "no shot" number. Eventually even down to 90. But you aren't there yet. Another technique you can try next time is to stall 20-30 minutes and see if he is going up to a number you feel comfortable shooting. You can still stay on schedule if you shoot 1/2 hour late.

Shooting early this PM was fine, you want to make sure shots are at least 12ish hours apart and it was that.


You have to do one curve in the 7 days you hold the dose, it doesn't have to be the 7th day. It can be a couple days earlier if that works better for your schedule. If you don't shoot, then doing a curve doesn't make sense. Similarly, try to avoid a cycle where he's bouncing as the curve then won't tell you much. The "if nadirs are between 90 and 149" part refers to nadirs (note the plural) and any time you test during the 7 days.

You do want to stay on this dose and gather more data to answer the question "how low is this dose taking my cat?". More spot checks during not curve cycles can help you do that. With a PMPS of 8:30, can you get a 10:30 test before bed? Many cats go lower at night and it'd be useful to get those before bed tests to find out what is happening then. The skip has also depleted the depot, so you'll likely need at least 3 more days on this dose.

Hi Lisa,
I had very similar questions and fears in my post yesterday.
? - 23/02, Maggie, AMPS 345 / +3 223 / +5 124 / +6 126 / +8 151 / +10 187

The advice and support I received really helped me see things more clearly and feel more confident.
I hope reading through it helps you too, the way it helped me. We’re all learning, and we’re not alone in this.

Thanks for sharing what you're experiencing- this really can be nerve wracking!

 

[leeza]

Here's the link to your previous post here, which we like to see for continuity: Stuggling w/ Lantus SLGS - increased dose after 7 days, but numbers are going up

If you read further on the section on lower preshots in the SLGS dosing method, you'll see the following:

Summary, over time and with data, you can reduce the "no shot" number. Eventually even down to 90. But you aren't there yet. Another technique you can try next time is to stall 20-30 minutes and see if he is going up to a number you feel comfortable shooting. You can still stay on schedule if you shoot 1/2 hour late.

Shooting early this PM was fine, you want to make sure shots are at least 12ish hours apart and it was that.


You have to do one curve in the 7 days you hold the dose, it doesn't have to be the 7th day. It can be a couple days earlier if that works better for your schedule. If you don't shoot, then doing a curve doesn't make sense. Similarly, try to avoid a cycle where he's bouncing as the curve then won't tell you much. The "if nadirs are between 90 and 149" part refers to nadirs (note the plural) and any time you test during the 7 days.

You do want to stay on this dose and gather more data to answer the question "how low is this dose taking my cat?". More spot checks during not curve cycles can help you do that. With a PMPS of 8:30, can you get a 10:30 test before bed? Many cats go lower at night and it'd be useful to get those before bed tests to find out what is happening then. The skip has also depleted the depot, so you'll likely need at least 3 more days on this dose.

Thank you so much for answering my questions! Kuro's numbers were all in the 300's today, and he seems to be feeling better. I'll stay at the 1.75 units until the weekend and do a proper curve then.