Low Preshot numbers

[Mouse & Me]

I will be taking the cat in to the vet tomorrow for bloodwork, (seeing if her lyme disease is better), and wanted to ask questions....I prefer to know some answers first, before asking THEM. Less likely to get talked into bad advice, or unecessary tests.

Lately, my cat is getting late Nadir, like around 10th hour, or even at preshot! This morning, she was at 68, (relion meter), fed her, waited 30 minutes, and it was 58! This is nothing new. I've learned to avoid the temptation to lower the dosage, and kept feeding small wet food snacks. True to form, at 4pm, her BG is at 257.

Could this be from the fact that she is near the end of her Lantus vial? I have a new one to try out, but didn't want to waste any. I've been using this vial since mid November.
OR, is this something else? If her Lyme numbers are up again, the vet is going to blame it on that factor, but I won't have those results until later this week. He says,"In his experience, her curves are just like the dogs who had lyme and diabetes." Not too many cats have the two. She's the odd one, especially when you consider the fact that she's an indoor cat.

 

[Dyana]

Good job on shooting this morning.
I don't see where her nadir is around +10 (in the past couple weeks). Can you help point me to where that is on your spreadsheet?
I'm sorry I know nothing about lyme disease in cats. I only know that twice I have had rounds of strong antibiotics for it, myself.

 

[Bobbie And Bubba]

Hi Diane,

It's hard to tell what is going on because the dosing hasn't been consistent. Back on 1/30 she had a 47 in the PM cycle which would earn a reduction but you kept the dose the same. Then on 2/5 PM you reduced her to 2.5u and the next AM you raised her back to 3 u . On 2/7 PM reduced her again and several times since then reduced and raised and reduced and raised. With Lantus, the depot needs to fill and with not holding the dose for at least 3 days (unless of course she goes below 50 on a human meter, ) the depot is disrupted and it makes interpreting her SS a bit harder. Also, we raise and lower doses by .25 unit so that you don't go pass the right dose which is easy to do if you are raising by .50u as you have sometimes done.

I hope some more veteran eyes will weigh in as I think she could be getting too much insulin and is bouncing and not enough time is giving to clear the bounce; it can take 6 cycles e to clear a bounce. See on 3/7 PM cycle she had a 60 and on the 5th cycle you raised her again when you should have held the dose .

I hope that her BW at the Vets comes back good . My vet has never had a cat with Lymes and I am sorry your baby had to get FD too.

 

[Sienne and Gabby (GA)]

One quick point, if you get a lower than expected pre-shot number, please don't feed. Wait 20 min or so and re-test. You may need to repeat this but you typically want to wait until you're seeing a rise in numbers before shooting and feeding. That said, if you feel comfortable shooting low numbers (i.e., anything above 50), go ahead and shoot. Many of us who are veteran Lantus users and who follow TR will shoot anything above 50. If you opt to shoot low, you do need to monitor, much like you're already doing, so you know what Mouse is going to do.

It does look like there were some inconsistencies with dosing in Feb. In contrast, you held the 3.5u dose for what looks like longer than you needed to. Have you thought about whether you want to follow the Tight Regulation Protocol or Start Low Go Slow? Which ever approach you think is right for Mouse (and frankly, you test enough to use TR), I'd encourage you to really stick with the letter of the approach and see how Mouse responds.

 

[Mouse & Me]

Good job on shooting this morning.
I don't see where her nadir is around +10 (in the past couple weeks). Can you help point me to where that is on your spreadsheet?
I'm sorry I know nothing about lyme disease in cats. I only know that twice I have had rounds of strong antibiotics for it, myself.

2/27 is one- she hit 181 at preshot time; 2/25= 146 at 10th hour.....I use my graph, to see it better (I use Excel)

 

[Mouse & Me]

One quick point, if you get a lower than expected pre-shot number, please don't feed. Wait 20 min or so and re-test. You may need to repeat this but you typically want to wait until you're seeing a rise in numbers before shooting and feeding. That said, if you feel comfortable shooting low numbers (i.e., anything above 50), go ahead and shoot. Many of us who are veteran Lantus users and who follow TR will shoot anything above 50. If you opt to shoot low, you do need to monitor, much like you're already doing, so you know what Mouse is going to do.

It does look like there were some inconsistencies with dosing in Feb. In contrast, you held the 3.5u dose for what looks like longer than you needed to. Have you thought about whether you want to follow the Tight Regulation Protocol or Start Low Go Slow? Which ever approach you think is right for Mouse (and frankly, you test enough to use TR), I'd encourage you to really stick with the letter of the approach and see how Mouse responds.

There is truly inconsistency, I got nervous when it got close to an hour after 12th hour, and the number wasn't going up. Especially if it was late at night. The type of regulation is a new thought process for me....I'll study up tonight. Luckily, I work at home, so I can test and observe til bedtime.
So, in the 50s for preshot, is ok?

 

[Dyana]

On 2/27 it looks like she was bobbling around after a bounce. I can't speak for 2/25 though.

 

[Sienne and Gabby (GA)]

If you still feel like you're getting your sea legs with shooting low numbers, work your way down to shooting above 50. Most of us don't do this at first. It's a matter of become "data ready." (See the sticky on Shooting and Handling Low Numbers.) Part of the process is knowing how your cat responds to Lantus and how to manage low numbers. For example, just how carb sensitive is your kitty? Do you have a good sense of when insulin onset and nadir occur and how much duration you're getting? All of that factors in to becoming ready to shoot low numbers.

Also, if you have a low pre-shot, post and ask for help by putting something in your subject line. People will not only give you guidance, they'll stick around so if you're nervous, there will be members experienced with handling low numbers to walk you through the process.