Pre-shot, how low is too low?

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Dragonfly229

Dragonfly229

Member Since 2012
Linus has been doing some weird surfing, he seems to be on a 3-4 day cycle of highs and lows. Tuesday's PMPS was 90 after a +7.5 of 279 (from memory). Tuesday morning's pre shot was about 290. Monday's numbers were in the 300's all day. So I skipped his shot last night because I can't shoot a 90, right? Especially when I'm here at work and everyone at home is sleeping. So in the morning, he'll be back in the 300's, and we start over. I've gotten brave and shot some 130-140's, but I don't know if I should go lower. Sometimes after shooting low, he bounces right back up, sometimes he stays lower for a shot or two and then goes back up. I'm realizing that the insulin wears off in a hurry, he can go from a great low number to a high one in a matter of a few hours. So maybe I would be ok to shoot at 90, and then be sure he has lots of yummy food to eat. Coming from using ProZinc, I'm just not comfortable shooting below 150 or so. His current dose is 3u, I haven't wanted to change until I get some more understandable numbers, but that's not happening.

I know our times are screwy - some of it is our schedules, and some is those low pre shot numbers. If I can, I wait and shoot later, but then usually end up having to split the difference down the road to get back on a workable schedule.

I've put some recent numbers in the spreadsheet, there's a gap where I'm not caught up.

Has anyone had a cat that did highs and lows in a 3 day cycle? How the heck do you manage it?
 
How about shooting a reduced dose?

When Sneakers is too low for me to shoot a full dose I will either shoot 50-75% of the dose, depending on how low she is.

Otherwise I do come home to a pink number or higher.

Hope this helps.
 
Try waiting 15 - 20 minutes without feeding and retesting to see if his number is rising. That information is useful to know.

The pattern you're describing, plus the long time Levemir lasts, makes me wonder if the dose is too high, especially since you describe it as a repeating cycle. Maybe backing off the dose a smidge would let it level out more.

Ideally, you want a dose you can shoot safely every 12 hours, without risking hypo numbers, and keeping as much time as possible in normal glucose levels. Over on Lantus, I have seen some folks shoot at or below glucose levels of 100 because they have data showing that it works for that cat. "Shoot low to stay low". This is something you'd want to try when you could be home to monitor, obviously! You get there by slowly lowering the no shot level and vigilantly testing the likely nadir period. (I'm not brave enough to shoot below 100 either!)
 
(can you put your dose in the SS somewhere? Maybe in the PS box? It makes it "easier" to figure things out - which is hard with your format anyway).

Some of the factors in his swinging numbers are:

Schedule (not much you can do about it, but maybe we can figure out some workarounds)
Dose
Skipping shots

First, I think your dose is too high. That is what causes swings from high to low and back. A lower dose will let things even out. Sometimes you need to decrease enough to stop the swings even if the numbers settle in the upper 100s/lower 200s - then slowly raise to being all the numbers down together.

I would suggest dropping to 2u and see if that helps even things out.

Swings are not being caused by the insulin wearing off really fast as you stated, but from rebound and skipped shots. With this insulin, compared to PZI, the duration is much longer (over 12 hrs) and you have overlap between doses. What that means is that the number you see "right now" is effected by several dose cycles. If you skip a dose, especially after a rebound has started off a low number (exactly what caused you to skip the shot), then the BG is climbing because of rebound AND there is no insulin coming on board to deal with it. It is always better to shoot something. What you shoot depends on your data, if you will be there to monitor and so on.

As you have noted, he climbs out of those lows (for the reason I stated above most likely) and it would be safe to shoot something on them. Maybe a reduced dose until you have the data to show a full dose is safe (or not).

My Jeddie cycled high to low on a multi day basis and it was tough for me to get it straightened out. I kept thinking it was from too much insulin and would reduce, but I would get the same pattern of numbers. Still, I think that reducing for Linus is probably needed.

BTW, getting BG tests +/- 1 to 2 hrs of the shot time can often show you if he is rising or falling at shot time. The caveat to that is with is non-standard schedule he will be harder to predict on that even with data, but you might find that on a shorter cycle he is still falling, or steady and on a longer cycle he is climbing.

Also remember that shooting early = a dose increase and shooting late = a dose decrease in terms of understanding the numbers. I don't think that you want to start changing the dose each cycle to try and compensate for the length of the cycle. But there are techniques you can use to that we could get into discussing once you get the basic dose closer to holding him steady.

Does all that makes sense? Questions? I think one of the issues is the change in approach from a short acting insulin to a long acting insulin. It took me months to feel comfortable with lev and shooting low numbers, for instance. Now I can barely remember what it was like with the shot acting insulin. It just another learning curve, I guess.
 
Thanks, everyone! I had wondered if he was bouncing, but I sure took my time getting to this dose and thought I had covered my bases there. Maybe he's headed toward OTJ and just needs less insulin now. That would be a happy miracle. It was surprising how high he could get so quickly after a shot, I knew the insulin was supposed to overlap and yet it just seemed like it must be gone.

Tonight I reduced the dose to 2u, I'll do my best to keep the schedule regular and see where this goes. He was really high this morning at +24 after the skipped shot last night (400+), but back down to 300 PMPS tonight. He's been in the 300's pretty much since he was diagnosed 1/2012, so if he goes back there it's ok. It has been nice to see the lower numbers, but they have been so random I can't tell what is causing them.
 
Hi Sue! Hello Linus Buddy!!!

You're seeing some of the changes I've seen here as well. When we were on ProZinc, I saw a food spike of 30 points per can. Almost like clockwork. Here on Lev, it's sometimes as much as 100 points. Only the insulin has changed.

Another thing I've found... I can either delay or reduce if he's low at shot time. Not both. We lose too much ground if we do both. So if I delay, it's usually an hour and he's climbing, so no big deal. If I do a reduced shot the recovery time varies. I've done some REALLY conservative reduction shots, like 50%, and it's been fine. I've also done some 75% without much excitement.

It was a real change coming here and seeing people shooting 75s and other numbers. I really spent some time studying spreadsheets. I took the plunge one night and shot a 92. Spent the first 5 hours up testing and watching him, then up every hour or two to check & feed. For your own sanity, I recommend a higher no shoot number! But likewise, if you'll be home, and able to stay up, it never hurts to see what they do. Just make sure you've got some gravy food around. Saved me last week. One can 20% chicken w/ gravy made him jump almost 100 points in 30 minutes! I also did spoons of 20% which was a better rise.

It's so nice that Linus is seeing movement - just remember, the timing is SOOOO much different than ProZinc. Instead of 6:30 shots, I now shoot at 10:00 or so. This means a) I can sleep, and b) I can work with only a slight interuption to shoot him. Otherwise, his potentially low number times are when I'm home and awake. I know your schedule isn't quite so flexible, but maybe there's something you can do to get a check on him - without it controlling every non-work second of your life.

Hi to Alec and skritches to Linus - G said to tell him NO MORE PANCAKES!!! (but gravy is YUMMY!!!!) :lol:
 
Hi Sue -

Hoping Linus has settled in a little better for you. I know the ups & downs are frustrating, and some things we have no control over...

That being said, I'll echo what was said above - if he's low, I would shoot a reduced dose. If you take a look at G's SS, you'll see I had some reductions in March. It was also a VERY crazy time at work, and I had to be VERY conservative (not to mention he had some reductions). But I've learned I can EITHER delay a shot or shoot a reduced dose if he's low. I no longer skip a dose. Recovery takes way too long, as the shed gets drained... and we're at a week or two week setback until we can get back to where we need to be.

I shot a 92 once... and ended up being up half the night. Can't do that when you've got to be alert and functioning at work in the morning! The other side of the coin is, where Grayson used to spike 30 pts from a can of FF on ProZinc by +1... on Lev, he continues to climb until usually +4. So even if he's 130 @ PS, there's a good chance he'll be 240 by the time the Lev onsets @ +4. So in that case, I'd usually shoot the full dose (or just a little less). He nadirs about +8-10... so the curve is much later than on ProZinc.

Hope that helps. Skritches to Linus!
 
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