? Need advice on dosage/shot times

[katiesmom]

Please see Katie's SS. I am unsure what to do. This has been very unusual. She has repeatedly (especially the last week) been what I consider to low to shoot at shot time. So I stall and shoot late. It's happened every day now for the last 4 days and several more times in the last couple weeks.

My personal cut - off point is 120. Many shots have been hours (and hours!) late waiting for her numbers to rise enough to be "shootable". I hate to keep screwing up her shot times like this, but don't want to risk her going to low. There has even been occasions where her +14 will be lower than a +12.
I know many people shoot at lower numbers. I am a coward. I cannot do that, I am too worried about a hypo. I have seen her go from 200 to 100 on a small amount of insulin in the past and she seems to be rather unpredictable and I just cant take that chance.

So...do I reduce her shot do you think? Or do any cats get injections in 14 or 16 intervals instead of 12?
I love that her numbers have been good, and I dont want to screw everything up by reducing if I shouldn't, and stalling, because she has surprised me in the past and suddenly develop high numbers after weeks with good, steady numbers. I keep waiting for the other shoe to drop.

Please note- her SS is not filled out for Feb-mid May. I was sick and wasn't updating her SS , just writing her #s in a notebook at home. I am working on getting them filled in, but the last month is filled in.

And I know I need to get more testing done +3s, 4s, and 5s. I do tend to test later in the cycle because that seems to be her nadir typically. But she may be going lower earlier now, I don't know. Its doesn't seem like anything is typical these days.

Thanks in advance for your help.

 

[Wendy&Neko]

For people following SLGS, the no shoot value is below 90. You have lots of data on Katie. Have you thought of lowering your no shoot value if you are around to monitor? Maybe try 110 next, then 100. Both of those values are within meter variance of 120 which you are doing now. Cats cycles really do go flatter if you shoot lower numbers. I loved giving insulin when Neko was in the 80's (following TR) cause it usually meant she'd move no more than 10 points the entire cycle.

With a kitty coming out of remission, you do have to try to be a bit more aggressive. Shooting 100 and above is not aggressive, once you have the data to do so. And a cat's cycles may look different than the first time they were on insulin.

 

[Cherryl & Mouzer]

I can relate to your fear. You even have a little lower fear level than I do haha Mine is 130
Actually, I think mine is 170 - I see 130 and wont shoot but I dont even have the nerve to shoot unless it is 170.

 

[Bobbie And Bubba]

Hi Katie's mom. I agree with Wendy about being more aggressive with her 2nd rodeo on Lantus ( Bubba had 3 and is OTJ presently) You are testing enough for TR and if it were my kitty, I would switch to TR so you can change up doses faster and get her into all numbers under green faster and get her OTJ. IMHO But, the very least, lower her no shot number so you can get her into all greens faster.

 

[katiesmom]

Thanks for the replies. I may be a bad mom, but I just cant do TR.

Part of the reason why- I cannot steer her numbers with food if her numbers go too low like most people can do.

She has been on raw food for 9 years. My homemade raw the last 4 years because the commercial raw stuff was making her sick. She has hyperlipidemia which the vet thinks contributes to her FD. So I have to make her food ultra low fat, trimming ALL the fat off the meat and replacing it with omega fatty acids to keep it in check. Once I started doing that, she went into remission the first time.
The last time she had anything other than raw to eat it made her sick also, many years ago, it made her vomit. So I cannot count on giving higher carb food or even honey/karo if I need to, most likely wouldn't eat it (she never liked canned food) and even if she did, wouldn't keep it down. So I have to be very cautious. I don't ever want to find myself in that situation. My motto is to keep her safe.

It's been 12.5 hours since last shot , which was 3 hours late because of low numbers too. Her PS just now is 95. I cannot shoot at that. It's the 5th time in 7 cycles she has been too low to shoot. So I am stalling once again.

My question again, do I reduce her shot to a .25 when it's safe to shoot, do you think? Or do any cats get injections in 14 or 16 intervals instead of 12?
Thanks!

 

[Gill & George]

She didn't drop below 90, so didn't 'earn' a reduction, so in theory you should stick with the dose.

Do you want to test her again, see where her numbers are heading? (just checking you haven't fed have you?)

Do you have to leave for work soon?

 

[Gill & George]

My question again, do I reduce her shot to a .25 when it's safe to shoot, do you think? O

If you shoot any insulin, because of the depot, the first half of the cycle will likely play out pretty much the same.

Ideally you would shoot the full dose, like Wendy, I found that when George got into lower PS, he really flattened out with maybe no more than 10-15pts difference between naddir and preshot. It is a leap of faith and you want to be able to monitor the first time you do shoot lower.
95, on SLGS is still a safe number to shoot on SLGS, once you build yourself up to it of course.

If you can be there to monitor the first few hours of the cycle, if he is flat or coming up, I would shoot the full dose.

If you are not able to monitor, then I would prefer to see a significant rise in numbers before you shoot and leave, purely from a safety point of view, when you shoot lower than you previously have shot it's best to ensure that you are able to monitor.

Do you have an automatic feeder?

 

[Gill & George]

Sorry just re read your post and I missed this

So I cannot count on giving higher carb food or even honey/karo if I need to, most likely wouldn't eat it (she never liked canned food) and even if she did, wouldn't keep it down.

Would the honey make her sick? You could bump the carb content in the raw by adding some honey to that. We've had folk where kitties have intolerances and restricted diet and have found that a good way to steer the numbers. Karo and corn syrup, might be less appropriate choices, as I believe it's not unusual for kitties to have intolerances to the starch from those.
I can understand your concern at feeling unable to steer the numbers.

As I think has already been said, the second time round, if you are hoping for a strong remission, it can be beneficial to be a little more aggressive with the numbers than the first time round, but it does seem like you are in a bit of a quandary if you cannot use anything to bump her numbers up should you need too.

My fear if you take her down to 0.25u before she's earned it is that you will see the numbers rise, on SLGS that would mean holding onto a dose that's not working for her for a week (there is no allowance for a failed reduction) and that it will negatively affect the chances of that second remission that you are hoping for.
But I suppose it is an option if you truly are unable to steer her numbers just so long as you are aware that it might see her run high.

ETA looks like she staid flat at +12.5, maybe a skip tonight and then you can shoot at the normal time tomorrow morning (if she's high enough) seeing as you are practically 4 hours off your normal schedule??

 

[katiesmom]

I dont know if honey would make her sick. I never tried it on her, and since everything else seems to make her vomit, I assume honey or karo would too.

I asked about the reduction because even though she didn't technically reach 90 on her last cycle, her +8 was 93, and she could have went lower than that earlier in the cycle when she wasnt tested.
I guess my rational is, if a .25 would hopefully keep her low, but shootable every 12 hrs, wouldn't that be better than a .5 every 16 hours or so, because I have to keep stalling for a shootable number? I know it's not exactly protocol, but...

That's what I kinda did. Her PS was 95. I waited 4 hours and tested and she was up to 109. I did shoot at 109, but couldn't bring myself to more than a .25 at that number. I guess I will see how it works, and if it doesnt, well, I guess I only have myself to blame. Unfortunately I don't think the whole .25 got in her, because there was quite a bit of insulin left in the syringe after the shot. I know that happens sometimes ( I call it "backwash"), but on a little amount like that, that could be half the shot! I guess we'll see.

 

[Gill & George]

I know that happens sometimes ( I call it "backwash"),

I've had that happen, then someone suggested that when I shot I should hold the plunger down, pause a couple of seconds and remove the needle while still holding the plunger down, that solved the backwash issue, and with the small doses made sure george was getting most of the shot.

I guess my rational is, if a .25 would hopefully keep her low, but shootable every 12 hrs, wouldn't that be better than a .5 every 16 hours or so, because I have to keep stalling for a shootable number?

It is something that we suggest to folk when they find themselves skipping and delaying shots. As you recognise 'not strictly protocol' but you do have some extenuating circumstances with the food issue.
I think the honey or maple syrup would be a better option for steering than karo, (should you need it) as she has sensitivity issues, I seem to remember some kitties have problems with Karo (cornsyrup)