New member. Some questions after reading the stickies

N

Nate2021

Member Since 2021
My cat Brian was diagnosed about a week ago, but I've only just started testing today. He was monitored by my vet who started him on 1.5iu due to his size, and after a week decided to bring him up to 2iu. I am now testing for myself.

I'm going to attempt tight regulation, but my question is as his numbers start to level out, what is the number I shouldn't shoot at? I know I'll need some time to gather enough data to predict what he will do over the first half of the cycle, but hypothetically if I know he will rise for +1 and +2 start to drop, but his preshot number is say 250, do I still shoot?

Or, if during usual cycles there is a drop from 400 to 150, but on one day the preshot number is 250, would shooting lead to hypoglycaemia? Meaning the insulin would still have the same power to lower the BG?

Sorry if I'm not making sense
 
Nate2021 said:
My cat Brian was diagnosed about a week ago, but I've only just started testing today. He was monitored by my vet who started him on 1.5iu due to his size, and after a week decided to bring him up to 2iu. I am now testing for myself.

I'm going to attempt tight regulation, but my question is as his numbers start to level out, what is the number I shouldn't shoot at? I know I'll need some time to gather enough data to predict what he will do over the first half of the cycle, but hypothetically if I know he will rise for +1 and +2 start to drop, but his preshot number is say 250, do I still shoot?

Or, if during usual cycles there is a drop from 400 to 150, but on one day the preshot number is 250, would shooting lead to hypoglycaemia? Meaning the insulin would still have the same power to lower the BG?

Sorry if I'm not making sense
Click to expand...
You're making sense, and then not, if that makes sense?
The answer is, that's why we're testing as idiots. You can shoot - with time!!!! - let's say 60, safely, but no one knows how or when a cat wants a reduction. It might happen on 250, or not. Look at @Hercule's mum spreadsheet, Hercules is sometimes all over the place, still earning reductions. There's never a number where you can say, this amount is safe to shoot and then not test.
I'm so sorry it wasn't what you wanted to hear, but that's exactly why we test, and why we focus on safety.
I wanted to know the same when I started out..

I might be a help to you to look at other people's spreadsheets and see how cycles can look. Hercules bounces a lot sometimes, mine haven't until recently, and then there's those who just doesn't bounce, and those who surf all day long :D

Now its time to gather data, then you'll gradually learn how Brian responds and learn to shoot low to stay low, as we say.

Maybe this doesn't make sense either :joyful::D
 
SashaV said:
You're making sense, and then not, if that makes sense?
The answer is, that's why we're testing as idiots. You can shoot - with time!!!! - let's say 60, safely, but no one knows how or when a cat wants a reduction. It might happen on 250, or not. Look at @Hercule's mum spreadsheet, Hercules is sometimes all over the place, still earning reductions. There's never a number where you can say, this amount is safe to shoot and then not test.
I'm so sorry it wasn't what you wanted to hear, but that's exactly why we test, and why we focus on safety.
I wanted to know the same when I started out..

I might be a help to you to look at other people's spreadsheets and see how cycles can look. Hercules bounces a lot sometimes, mine haven't until recently, and then there's those who just doesn't bounce, and those who surf all day long :D

Now its time to gather data, then you'll gradually learn how Brian responds and learn to shoot low to stay low, as we say.

Maybe this doesn't make sense either :joyful::D
Click to expand...
Cheers for that, it makes sense. I plan to always be testing no matter what, just the concept of giving 2iu with a BG of 200 stresses me out, I guess confidence comes with data
 
Hi Nate. Welcome to the forum!

Like you I used to think that a dose X would reduce BG by Y, in somewhat predictable linear fashion. Unfortunately doesn't quite work like that. That is why dosing is determine by how low a dose gets kitty and not where the start before the shot.

Since you are starting I reccommend you be very careful and follow protocol:
  • 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.
Once you know your kitty better you can become more daring :)
 
Another mantra you will hear a lot in this forum is... every cat is different (ECID)
2 units would probably kill Hercules.... you can see how much he dropped today with 0.15U. However, you can also find other cats that 7U does not do anything.
I promisse it will all get eaier with time, and ask away whenver you are unsure. The forum is super friendly!
 
Hercule's mum said:
Hi Nate. Welcome to the forum!

Like you I used to think that a dose X would reduce BG by Y, in somewhat predictable linear fashion. Unfortunately doesn't quite work like that. That is why dosing is determine by how low a dose gets kitty and not where the start before the shot.

Since you are starting I reccommend you be very careful and follow protocol:
  • 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.
Once you know your kitty better you can become more daring :)
Click to expand...
Awesome this was exactly the type of guideline I was looking for. My vet said that cats can be finicky and variants can change things, some weeks the pancreas will need more assistance than others, hence why home testing is so important. Thanks for the guide!
 
Hercule's mum said:
Another mantra you will hear a lot in this forum is... every cat is different (ECID)
2 units would probably kill Hercules.... you can see how much he dropped today with 0.15U. However, you can also find other cats that 7U does not do anything.
I promisse it will all get eaier with time, and ask away whenver you are unsure. The forum is super friendly!
Click to expand...
Just checked your spreadsheet and a few others, the differences are pretty extreme. Thanks heaps for the help
 
Hi Nate and welcome! Karen very kindly provided you with the info I believe you’re looking for. Please feel free to peek at my Ruby’s SS to see that shooting below 200 is very much safe, it’s just a matter of gaining experience working with your cat through some low number situations and following the excellent advice of the experienced members and mods of this board. You’ll do great!
 
Nate2021 said:
Cheers for that, it makes sense. I plan to always be testing no matter what, just the concept of giving 2iu with a BG of 200 stresses me out, I guess confidence comes with data
Click to expand...
That's where the magic happens. You'll never be alone :bighug:
There's almost always someone here who will be there for you, guide you and be with you if and when Brian earns his reductions.
Confidence comes with data yeah, and then not. I'm still terrified at times.
 
Hercule's mum said:
Another mantra you will hear a lot in this forum is... every cat is different (ECID)
2 units would probably kill Hercules.... you can see how much he dropped today with 0.15U. However, you can also find other cats that 7U does not do anything.
I promisse it will all get eaier with time, and ask away whenver you are unsure. The forum is super friendly!
Click to expand...
Karen, Herc and Mauer must be twins in this sugarworld! Mauer's pmps was the cycles lowest number too :rolleyes:
 
SashaV said:
That's where the magic happens. You'll never be alone :bighug:
There's almost always someone here who will be there for you, guide you and be with you if and when Brian earns his reductions.
Confidence comes with data yeah, and then not. I'm still terrified at times.
Click to expand...
"Confidence comes with data, and then not" AMEN, I've been so scared to shoot the last few days with the numbers I have and I've been at it for a year, but you never know until you try!
 
FrostD said:
"Confidence comes with data, and then not" AMEN, I've been so scared to shoot the last few days with the numbers I have and I've been at it for a year, but you never know until you try!
Click to expand...
Exactly! But it helps that there's always support right here, even if the other person is across the world. :bighug:
 
Nate2021 said:
My cat Brian was diagnosed about a week ago, but I've only just started testing today. He was monitored by my vet who started him on 1.5iu due to his size, and after a week decided to bring him up to 2iu. I am now testing for myself.
Click to expand...

Hi and welcome to the Lantus/Basalgar/Levemir subforum. I'm glad you are reading the stickies and asking questions :). As part of the dosing methods we follow here, we usually recommend doing dose adjustments in 0.25u increments. I'm glad you are starting to test at home, getting test data is very important in understanding how the insulin is working for your cat. We dose based on how low the dose is taking the kitty, not preshots, which is why getting additional tests helps determine whether the dose is working or not.

Part of that process is getting a feel for basic concepts:
  • Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
  • Peak/Nadir - the lowest point in the cycle
  • Duration - the length of time insulin continues to lower blood glucose
Many people on Lantus find that getting a +2 can be an early indication of how the cycle may go. If it is significantly lower, it means you'll need to continue to monitor , but if the +2 is higher than preshot, it usually means that you can take a break from testing.

Since you don't have much data yet, and are quite new to the process, we suggest you don't shoot if you get a preshot number under 200, stall (don't feed) and post for help. With more data, and following TR, that no shot number can go down gradually to shooting anything above 50.
Nate2021 said:
Or, if during usual cycles there is a drop from 400 to 150, but on one day the preshot number is 250, would shooting lead to hypoglycaemia? Meaning the insulin would still have the same power to lower the BG?
Click to expand...

You'll find that's not how depot insulins like Launtus and Levemir work. I know it is hard to appreciate until you see how Lantus works for Brian, but usually when you have lower preshots, you get flatter cycles.

What is your feeding schedule like for Brian?
 
SashaV said:
That's where the magic happens. You'll never be alone :bighug:
There's almost always someone here who will be there for you, guide you and be with you if and when Brian earns his reductions.
Confidence comes with data yeah, and then not. I'm still terrified at times.
Click to expand...
Tyvm
 
Christie & Maverick said:
Hi and welcome to the Lantus/Basalgar/Levemir subforum. I'm glad you are reading the stickies and asking questions :). As part of the dosing methods we follow here, we usually recommend doing dose adjustments in 0.25u increments. I'm glad you are starting to test at home, getting test data is very important in understanding how the insulin is working for your cat. We dose based on how low the dose is taking the kitty, not preshots, which is why getting additional tests helps determine whether the dose is working or not.

Part of that process is getting a feel for basic concepts:
  • Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
  • Peak/Nadir - the lowest point in the cycle
  • Duration - the length of time insulin continues to lower blood glucose
Many people on Lantus find that getting a +2 can be an early indication of how the cycle may go. If it is significantly lower, it means you'll need to continue to monitor , but if the +2 is higher than preshot, it usually means that you can take a break from testing.

Since you don't have much data yet, and are quite new to the process, we suggest you don't shoot if you get a preshot number under 200, stall (don't feed) and post for help. With more data, and following TR, that no shot number can go down gradually to shooting anything above 50.


You'll find that's not how depot insulins like Launtus and Levemir work. I know it is hard to appreciate until you see how Lantus works for Brian, but usually when you have lower preshots, you get flatter cycles.

What is your feeding schedule like for Brian?
Click to expand...
ty for specifying those details, that's what I was curious about. The vet said it may be another week before I really see how the insulin is working with Brian too. Good to know lower preshot usually means a flatter cycle. I feed him on demand as the vet did he needs to gain some weight, generally he has a friskies low carb can 30 minutes before his shot. At +1hr, +4hr and +8hr he has raw meat mixed with friskies pate but doesn't have much at these times. Then at +12 a good sized friskies can again. I have been leaving out some pate over night incase he goes low and needs it, and he is potentially having that an hour or two before I get his preshot number it's always gone when I wake up, should I stop leaving out over night?
 
You're welcome :). What is Brian's current weight? When you are first starting out, and getting a feel for how carb sensitive your cat is, and how much of a food bump they get, it is usually recommended to not feed 2 hours before shot, so as not to potentially artificially inflate the preshot number. This is moreso important when you get lower preshots, not so much when they are high.

The other thing to consider, as you gather more data, is trying not to feed after nadir (lowest point in the cycle), because that tends to put the brakes on duration of the insulin and BG numbers go up more quickly, where they may have stayed a little flatter, or gradually increased as the insulin wears off. The tricky part is nadirs can, and do, move around. They aren't always at +6 on Lantus.
 
We suggest to new people that they not feed for 2 hours before they get their preshot test. Otherwise the test will be influenced (inflated) by the food, and you won't know if the uninfluenced test number would be safe to shoot. Most of us test, feed, and shoot all within 10-15 minutes. Spreading out meals during the cycle like you are doing is a good idea, though it's better to feed more in the first half of the cycle. After nadir, the insulin effect is slowing down and adding carbs after that can slow it down even more, causing a loss in duration.

Another option to help you not feed overnight for the last couple hours before shot time is an automated feeder. You can get rotating ones like the Petsafe 5, and you can get it to rotate to an empty slot two hours before shot time.
 
Christie & Maverick said:
The other thing to consider, as you gather more data, is trying not to feed after nadir (lowest point in the cycle), because that tends to put the brakes on duration of the insulin and BG numbers go up more quickly, where they may have stayed a little flatter, or gradually increased as the insulin wears off. The tricky part is nadirs can, and do, move around. They aren't always at +6 on Lantus.
Click to expand...

Thanks Christie, I didn't know not to feed after nadir and I've been doing this for years! Explains a lot! BTW, I'm an FO for SWA - love to see another sky sister!
 
Hello I'll reply to every one I've missed asap. Just wonder if someone could have a quick glance at brians preshot and reassure me
 
Nate2021 said:
Hello I'll reply to every one I've missed asap. Just wonder if someone could have a quick glance at brians preshot and reassure me
Click to expand...
Its always hard to say in the beginning, but generally pink is pretty safe to shoot, especially with numbers you saw today. Can you check again around +3 and +5?

Is it actually PM for you?
 
I'm headed back to bed - if it were me I would shoot, and check again around +2/+3. If the +2/3 is below 200 (so a pretty good drop), check again around +4/+5. If in the 200s, check again around +5/+6.
 
FrostD said:
Its always hard to say in the beginning, but generally pink is pretty safe to shoot, especially with numbers you saw today. Can you check again around +3 and +5?

Is it actually PM for you?
Click to expand...
Thanks for replying frost. It's pm for me yep, but I'll stay up and do a 3 hour and set an alarm for a 5 hour. I actually "skinnied" the dose to maybe 1.9iu. Hoping it will be ok, he may not have his depot filled yet at this stage either, so potentially too high of a dose. We raised him from 1.5iu to 2iu after only a week, maybe it was too soon
 
Hi Nate, if did go ahead a gave a 1.9 instead of 2U dose, go ahead and write this in your worksheet. When I see a result later and is trying to find explanations, these little observations will help you. Not keeping good notes can give you quite the headache as I learned my self laste week. I changed the dose, couldn't remember exactly to what a few days later...:banghead::banghead:


Nate2021 said:
he may not have his depot filled yet at this stage either, so potentially too high of a dose
Click to expand...

The depot keeps the dose for longer. So not having a depot filled, would have make the shot "safer". I don't know if this analogy would be helpful, but think about putting a really wet sponge on top of a potted plant. It will release a bit of water to the plant over a period of time. Not all at once. If the sponge is completely dry (an empty depot) and you water the plant, all the water the plant gets is what you just gave. But if the sponge is wet (full depot), the plant will get a bit more than what you gave over the day. The nice thing about the sponge, is that keeps the plants with a bit of water the whole day, instead of going though a cycle of being over wet, and then over dry. However, it can make changes in watering protocol a bit tricky. If you want to keep the plant much drier, you have to remember that even though you will give less water, it will still get some from the sponge. But you really don't want to completely dry up the sponge or the nice little buffering effect will disappear. Everytime you rewater the plant, you refill the sponge. As the dose increases, the sponge remain "wet" for longer. when you reduce the dose, the sponge holds less water.

It is likely my analogy just got you more confused :D, so check out this sticky:

https://www.felinediabetes.com/FDMB/threads/what-is-the-insulin-depot.150/
 
Nate2021 said:
Thank youuu
Click to expand...
No problem! We call this a "before bed" check. If he's flat or higher than PMPS, can usually let them go til morning without more tests. Some cats are the exception and will drop later. If the before bed check shows a decent drop, you know to keep testing.

Look at my spreadsheet for the last few days, you can see when I saw big drops I continued to test. Sometimes hourly if under 120 or so, or if he wasn't eating.
 
Nate2021 said:
Just wonder if someone could have a quick glance at brians preshot and reassure me
Click to expand...
We determine how to change the dose based on the nadirs, or how low the dose takes the cats - not the preshot values. We tell brand new people on the Feline Health forum they are fine to shoot anything above 200. On this forum, for people following Tight Regulation - we suggest that you do not feed, and post for help when you get a number under 150 as a preshot.

I would go back to 2 units tomorrow - the dosing methods we use here work best when you shoot an consistent dose each time.

And one more thing, due to the number of kitties on this forum, we request that you do a new post for each new day that you post. It helps us help you with a fresh post.
POSTING GUIDELINES PLEASE READ
 
Hercule's mum said:
Hi Nate, if did go ahead a gave a 1.9 instead of 2U dose, go ahead and write this in your worksheet. When I see a result later and is trying to find explanations, these little observations will help you. Not keeping good notes can give you quite the headache as I learned my self laste week. I changed the dose, couldn't remember exactly to what a few days later...:banghead::banghead:




The depot keeps the dose for longer. So not having a depot filled, would have make the shot "safer". I don't know if this analogy would be helpful, but think about putting a really wet sponge on top of a potted plant. It will release a bit of water to the plant over a period of time. Not all at once. If the sponge is completely dry (an empty depot) and you water the plant, all the water the plant gets is what you just gave. But if the sponge is wet (full depot), the plant will get a bit more than what you gave over the day. The nice thing about the sponge, is that keeps the plants with a bit of water the whole day, instead of going though a cycle of being over wet, and then over dry. However, it can make changes in watering protocol a bit tricky. If you want to keep the plant much drier, you have to remember that even though you will give less water, it will still get some from the sponge. But you really don't want to completely dry up the sponge or the nice little buffering effect will disappear. Everytime you rewater the plant, you refill the sponge. As the dose increases, the sponge remain "wet" for longer. when you reduce the dose, the sponge holds less water.

It is likely my analogy just got you more confused :D, so check out this sticky:

https://www.felinediabetes.com/FDMB/threads/what-is-the-insulin-depot.150/
Click to expand...
Good point, I adjusted the notes for accuracy. I'll happily learn from your experience on this one. OK that analogy makes sense to me cheers for that. Just looking at what happened overnight last not I'm a bit confused he didn't eat anything but had shot up in the +8 when I got up to test him a bit of a contrast from the previous cycle when he was eating, could that type of variation be due to the depot taking more? Or a bounce? His numbers were not too bad yesterday with some still going to the buffer and the preshot was lower than it has been. I know we have no info really to work with haha
 
Wendy&Neko said:
We determine how to change the dose based on the nadirs, or how low the dose takes the cats - not the preshot values. We tell brand new people on the Feline Health forum they are fine to shoot anything above 200. On this forum, for people following Tight Regulation - we suggest that you do not feed, and post for help when you get a number under 150 as a preshot.

I would go back to 2 units tomorrow - the dosing methods we use here work best when you shoot an consistent dose each time.

And one more thing, due to the number of kitties on this forum, we request that you do a new post for each new day that you post. It helps us help you with a fresh post.
POSTING GUIDELINES PLEASE READ
Click to expand...
Sorry I replied to the other person and had given Brian his shot before I read this.noted for next time though cheers
 
What you could have seen last night was a bounce, or reaction to the low yellows. He's probably not used to them yet.
 
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