No shot again? Or a half dose???

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heidi

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Hi, everyone.
Frodo is still staying low with very little insulin after a mild hypo on Tuesday. This is all very new to me, so I don't know the general guidelines for when to skip a shot or when to give a "fat" or "skinny" shot or a reduced dose. Any ideas what to do here? His pre-shot number was 162. I think I read somewhere to not give a shot or to adjust the shot if it was under 200?

Frodo's SS starts when I started trying to test (still hard but getting much better BTW, thanks to all your great suggestions!) He was diagnosed in mid-Dec and was on 1.0 unit of Humulin N 2 x day. Really high numbers when we did the curve at the vets 2 weeks ago (he didn't give them to me). We switched to 1.5 units Lantus 2 x day starting 1/15 (4 days before the SS starts).

I have not given Frodo a shot yet tonight, but he has eaten. Tonight's pre-shot test was at exactly 12 hours after this morning's shot.

Thanks!
Heidi
 
Hi Heidi,
I wish I'd seen this before now...
Did you skip shooting tonight? If so, that's fine.
I think I would try going with a .5u in the morning and in the evening on Friday. It would be best if you can find a dose that will let you shoot every 12 hours instead of being stuck with a dilemma at shot time. If you can get a shootable number for each PS test, then you'll have insulin on board around the clock. You might also consider posting a dose question in the Lantus TR forum in the morning. That forum is the busiest, and everyone there "knows" the insulin. There are always people on line there in the morning...

Carl
 
I'm thinking 0.25 to 0.5 units, ie a token dose, to allow the shed to drain a bit more, since you've dropped from 1.5 to 1.0 in the last couple of days and are still getting numbers that are too low to shoot. It takes 5-7 days for a dose change to result in stabile glucose levels.

Also, without more weeks of data, you don't know what the normal response is going to be, so being conservative is usually a good idea.

This should bump the topic up the list, too.
 
Hi,

I am definitely no expert...but I wanna let you know that I have been where you are.

My personal guidelines for shooting with lower numbers are that if I am around and can test, I will do a slightly reduced dose (.75 or .5) when Louie is around where your kitty was. But If I know I will not be able to check his bg's, I either skip it or give him just the tiniest trace amount.

That is just want I have found....I'm even cautious is Louie is in the low 200's or high 100's as there have been times where I gave him his dose at like 220 and kept and eye on him and he dropped into a range that made me nervous.

You are doing a great job!!!!
 
Heidi:

Just coming over from LL and can't tell if you shot or not. Please refer to "Dealing with Low Preshots" in my signature block.

Typically with new users, if the kitty is less than 200 you have three choices:

1. stall and wait for the number to rise and shoot the full dose on the rise; you would need to monitor closely and get a +1 and a +2 at the least to ensure Frodo is still rising. We typically don't stall more than two hours just because it gets
your schedule way off; you can make up the time in 15 min increments each cycle or 30 mins 1 cycle/per day. If you do 15 mins/cycle (meaning you would shoot 15 min earlier than you did tonight), you can start in the morning. If you do 30 mins/once a day then you would shoot tomorrow morning at 12 hours from tonight's shot and at +11.5 hours tomorrow night and so on until you catch up OR

2. shoot a reduced dose of say .5u tonight but I think that is not a possibility because you wouldn't stall AND shoot a reduced dose. When shooting a reduced dose, you still need to get a +1 and +2 and make sure where kitty is headed OR

3. skip the shot; if you skip, then you can pick whatever time in the morning to shoot that puts you back on your schedule or if you want to change your shot time, you can do it in the morning and then just start shooting every 12 hours from then.

There are two protocols for lantus/levemir:

The Tight Regulation protocol was developed based upon the premise that a cat's pancreas may be able to heal and return to producing insulin if the cat's BG is kept in a normal range, ie, 50-120. caregivers following this protocol adjust insulin doses following the protocol guidelines, to aim for that range. in order to follow the TR protocol, caregivers need to test a minimum of preshot time (to determine if it's safe to give insulin) and during mid-cycle (to find the lowest point of the cycle in order to determine dosing). if the cat is likely to get into low numbers, then the caregiver needs to test enough to keep the cat safe. basic information on the TR is here: TR. if you want to follow the TR protocol, we strongly encourage you to post daily in the Lantus TR insulin support forum for a while to learn more about how it all works. There are specific requisites to following the TR protocol. These include monitoring BG levels at least at PS, +3, +6, +9, learning the signs of hypoglycemia and how to treat it, preparing a hypo toolbox, testing regularly for ketones with urine ketostix, using the correct insulin syringes, feeding several small meals a day of a high quality, low carb canned or raw food diet.

The Start Low Go Slow protocol has caregivers start with an initial dose based upon the BG at diagnosis and whether kitty has been transitioned to a wet low carb diet, hold that dose for a week or two while testing for ketones regularly, being consistent with food and shooting every 12 hours. Once a week a curve is done (test every 2 hours for one cycle) to check for the lowest point. The low number in that curve determines any dose change for the following week. Basic information on the SLGS protocol is here SLGS. If you want to follow the SLGS protocol, you can post for advice on the Relaxed Lantus ISG, TR ISG, or Main health for guidance and support.

I hope this helps. He's looking great!!
 
Thanks, everyone for your thoughts and ideas.
I didn't get a chance to see your comments earlier this morning because of my normal chaotic morning getting out the door with twin three-year-olds, but I did get a successful pre-shot test again and gave him 1.0 units this morning. Thankfully the testing is getting easier and I'm confident I'll be able to keep getting successful pre-shot tests. And now I have some good ideas for what to do if I'm in the same situation tonight! I didn't like skipping the shot last night, but I also don't want to be in a situation of staying awake all night and worrying about him, especially since I have health issues myself and reducing stress and getting 8-10 hours sleep a night is part of my prescription plan (oops - failed this week!).

Thanks again! It sounds like I should head over to Lantus Land soon.
Heidi
 
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