Midnight's blood sugars 5/1/13
- Thread starter TMR
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TMR said:
Not to become some sort of data geek, but its interesting how your numbers have been at the same dose at about the same time over a couple of days. I see you followed the general guidelines not to shoot a number below 200 at preshot....and I think that was a smart decision at this point.
The result may be a higher than usual number tomorrow but that's not anything to worry about - it just is what a skipped shot usually does....heck everyone occasionally hits fur instead of skin and get the same effect. I'm really glad to see Midnight in numbers that aren't so low to be scary and aren't so high to be dangerous.
Good job Midnight....and is the name because she's a black cat?
Em
MommaOfMuse
Member Since 2010
If you find yourself consistently having to skip a shot because she is under 200 at preshot then you will want to drop her down to .75u. To do that you will need syringes with .5u marks and the easiest way I have found to eyeball it, is to line up the top of the plunger with the bottom on the line of the next higher dose. So basically for a .75u you want the top of the plunger resting against the bottom of the 1u line. There should be a small sliver of daylight between the bottom of the plunger and the .5u line.
Mel, Maxwell, Autumn & The Fur Gang
Mel, Maxwell, Autumn & The Fur Gang
Yes, Midnight is black--although if the sun hits her fur coat a certain way, she looks brown, almost like chocolate! I already got syringes with 1/2 unit markings. I was told to maintain the current dose for a week and then do a curve, to see if the dose should be adjusted. I am not sure I understand the point of the curve if I am testing preshot and midcycle, but I will do it. I can either do the curve tomorrow, after about 4 days on the reduced dose, or next Monday, which would be a week after the reduced dose. Which would be better? Since I have only done one curve, and it has been quite a while, should I do it tomorrow?
TMR said:
The curve is to help make sure that you know how Midnight is reacting to her Lantus throughout a 12 hour period including where her personal lowest point (nadir) is.
Not all cats reach nadir (low) at +6 - some are much earlier, some later. So trhe curve will help you see where Midnights lowest numbers fall along the cycle - and it will also show you the best time to midcycle test for your cat. And as some of the more experienced folks have said - they really need to understand how Midnight is reacting to insulin over the course of a full day or night to give you advice about adjusting the dose to better regulate her levels.
The preshot and midcycle tests are both primarily to keep your cat safe - and if you discover that your cats BG is going so low as to be dangerous, then you adjust the dose down innediately to protect her. If her numbers are low before a shot - you skip it for the same reason.
I'll let the folks who are going to weigh in on the results say when they'd rather see a curve done........
And I have always wanted a cat like that, sigh.......she sounds gorgeous.
MommaOfMuse
Member Since 2010
Midnight sounds beautiful...now if you tell me that she is also long haired I think I might just swoon. As she already sounds very much like the boy that I lost to Cancer last year on November 14th.
As for the curve, I would wait and do it next Monday as with the skipped shot last night you have basically reset the clock on how many days she has been on a set dose.
Depot insulin like Lantus and Levemir can be a little tricky to understand in the very beginning in how their action works. Basically what Lantus does is when you inject it, it forms little time released crystals under the skin. If you think of it like when you pour either bath salts or Epson Salts into bath water, some of those crystals dissolve right away, and some slowly dissolve over the course of the bath. Which is kind of what Lantus does, when you first start a dose only about 25% of the dose actually goes to Midnight to help her lower her BGs, the other 75% is still sitting there under her skin, and are slowly dissolving over the next 16 to 24 hours. Then you give the next shot and 25% of it goes to Midnight to lower BGs and another 25% of the first shot is now also going to her to help lower her BGs and so on until her shed is completely full so that 100% of the dose is going to the cat to lower BGs. Because the 25% of the recent shot given is now combined with the 75% of those previous shots that are now active while the 75% of the recent shot is now refilling the shed.
So when you skip a shot or shoot late, part of the shed is drained, and more of the next shot has to go to make up that deficit. So the next shot doesn't deliver the same punch as it would have had not part of the shed been drained, so in effect it acts like a dose decrease.
This is very different than how insulin like Prozinc or NPH work which are In & Out insulin, with them, you give the dose it goes in, does it job lowering the BGs and is starting to wear off by the next shot time so there is little to no overlap.
Mel, Maxwell, Autumn & The Fur Gang
As for the curve, I would wait and do it next Monday as with the skipped shot last night you have basically reset the clock on how many days she has been on a set dose.
Depot insulin like Lantus and Levemir can be a little tricky to understand in the very beginning in how their action works. Basically what Lantus does is when you inject it, it forms little time released crystals under the skin. If you think of it like when you pour either bath salts or Epson Salts into bath water, some of those crystals dissolve right away, and some slowly dissolve over the course of the bath. Which is kind of what Lantus does, when you first start a dose only about 25% of the dose actually goes to Midnight to help her lower her BGs, the other 75% is still sitting there under her skin, and are slowly dissolving over the next 16 to 24 hours. Then you give the next shot and 25% of it goes to Midnight to lower BGs and another 25% of the first shot is now also going to her to help lower her BGs and so on until her shed is completely full so that 100% of the dose is going to the cat to lower BGs. Because the 25% of the recent shot given is now combined with the 75% of those previous shots that are now active while the 75% of the recent shot is now refilling the shed.
So when you skip a shot or shoot late, part of the shed is drained, and more of the next shot has to go to make up that deficit. So the next shot doesn't deliver the same punch as it would have had not part of the shed been drained, so in effect it acts like a dose decrease.
This is very different than how insulin like Prozinc or NPH work which are In & Out insulin, with them, you give the dose it goes in, does it job lowering the BGs and is starting to wear off by the next shot time so there is little to no overlap.
Mel, Maxwell, Autumn & The Fur Gang
I might just wait until next Wednesday then. I work Sunday night shift, so Monday I will be sleeping part of the day and it will be harder to do the curve than it would be tomorrow (I am off tonight and tomorrow night). When I only get about 3 hours of sleep normally before or after working night shift, to cut it down to 2 hours--in order to test her blood sugar every 2 hours--would make me feel pretty crappy. Next Wednesday is the next time I am off the night before and that night.
The only thing is, what if her blood sugar is low again between now and then and I have to skip another dose? I don't have that many times I am off 2 nights in a row and able to be home to do a curve.
The only thing is, what if her blood sugar is low again between now and then and I have to skip another dose? I don't have that many times I am off 2 nights in a row and able to be home to do a curve.
MommaOfMuse
Member Since 2010
Right now you have a couple of options.
Either drop the dose down to as low as .5u twice a day (granted she may run fairly high during that time) and then continue giving that .5u until you have the free time to run a curve and adjust the dose off those numbers. And try to get as many ketone tests as you can catch her in the litter box.
or
Keep her on the 1u and if you get another low preshot under 200 stall the shot 30 minutes without feeding and retest to see if she has come up closer to 200. Then shoot the full 1u late (you have a 30 minute either way without it effecting the shed too much). But if you pick this option you will have to be able to test again at +3, & +6 just to make sure she isn't headed for trouble.
Personally with your work schedule and busy life I think I would pick option 1 and drop all the way back to .5 keep the dose steady until next Wednesday and then run your curve. That way at least you know she is safe from hypo and that you will be able to get a full week's worth of 2 shots per day in. That will at least give you a solid baseline to base how much she is likely going to need to go up.
It is always easier to start lower than the ideal dose and slowly work your way up if the readings support the need for more insulin than it is to start too high and have to work backwards. And less risky.
Mel, Maxwell, Autumn & The Fur Gang
Either drop the dose down to as low as .5u twice a day (granted she may run fairly high during that time) and then continue giving that .5u until you have the free time to run a curve and adjust the dose off those numbers. And try to get as many ketone tests as you can catch her in the litter box.
or
Keep her on the 1u and if you get another low preshot under 200 stall the shot 30 minutes without feeding and retest to see if she has come up closer to 200. Then shoot the full 1u late (you have a 30 minute either way without it effecting the shed too much). But if you pick this option you will have to be able to test again at +3, & +6 just to make sure she isn't headed for trouble.
Personally with your work schedule and busy life I think I would pick option 1 and drop all the way back to .5 keep the dose steady until next Wednesday and then run your curve. That way at least you know she is safe from hypo and that you will be able to get a full week's worth of 2 shots per day in. That will at least give you a solid baseline to base how much she is likely going to need to go up.
It is always easier to start lower than the ideal dose and slowly work your way up if the readings support the need for more insulin than it is to start too high and have to work backwards. And less risky.
Mel, Maxwell, Autumn & The Fur Gang
I just updated the spreadsheet with today's sugars, so far. Quite high. I can't really do option #2 because I often give her insulin right before I go to sleep or work. For example, yesterday she had her morning insulin when I got up at 7 am and then her evening insulin at about 6:30 pm right before I left for work. Then she didn't get her morning insulin this morning until about 7:45 am when I returned from work. Then I went to sleep shortly after that. I try to keep it as close to 12 hours apart as possible, but there is only so much I can do with my work schedule. So I can't delay the dose and retest if I am about to go to work or sleep.
Anyway, based on today's high readings, do you still think I should drop the dose down to 1/2 unit for the next week?
Anyway, based on today's high readings, do you still think I should drop the dose down to 1/2 unit for the next week?
MommaOfMuse
Member Since 2010
First the reason she is high today is because you skipped her shot last night, thus draining her shed somewhat. That is normal and expected when a shot is skipped.
She is still showing response to the insulin today and since we really aren't exactly sure where her nadir is roughly just yet she may still continue to drop some more throughout the day.
If you go back and look at yesterday her lowest point was right before her pm shot was due so at least for yesterday her nadir was at +12 which is what caused you to skip the shot because she was below 200. Which is exactly what you needed to do with limited data to know it was safe to shoot low to stay low.
Now it is just collecting the data so you know when her nadir is roughly (they do move around some) and roughly when her onset (when the new dose kicks in and BGs start going down). As well as how well the dose is working for her.
You can either roll her back to .5 or .75u although with her recent diet change to a much lower carb load food I would be inclined to drop back to the .5u. Yes, she may run high that week while you are holding the dose steady, but it will give you a baseline to work off of to know when roughly the nadir is, when onset occurs and by how much her dose needs to be raised if any.
There is always a chance that once she settles on that .5u (It takes 3 days roughly for the shed to reset) that she may already be giving you great numbers. If not then we simply take the dose up again slowly until we find what works for her.
Mel, Maxwell, Autumn & The Fur Gang
She is still showing response to the insulin today and since we really aren't exactly sure where her nadir is roughly just yet she may still continue to drop some more throughout the day.
If you go back and look at yesterday her lowest point was right before her pm shot was due so at least for yesterday her nadir was at +12 which is what caused you to skip the shot because she was below 200. Which is exactly what you needed to do with limited data to know it was safe to shoot low to stay low.
Now it is just collecting the data so you know when her nadir is roughly (they do move around some) and roughly when her onset (when the new dose kicks in and BGs start going down). As well as how well the dose is working for her.
You can either roll her back to .5 or .75u although with her recent diet change to a much lower carb load food I would be inclined to drop back to the .5u. Yes, she may run high that week while you are holding the dose steady, but it will give you a baseline to work off of to know when roughly the nadir is, when onset occurs and by how much her dose needs to be raised if any.
There is always a chance that once she settles on that .5u (It takes 3 days roughly for the shed to reset) that she may already be giving you great numbers. If not then we simply take the dose up again slowly until we find what works for her.
Mel, Maxwell, Autumn & The Fur Gang
Thanks for all the suggestions. I just updated the spreadsheet with her pm blood sugar. I gave her 0.5 unit as recommended, although it seems like I should give her more. But I trust that you know a lot more about this than me. So I will plan to do the curve next Wednesday, when I can be home and awake all day.
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