Shooting low, test/feed or feed/test and other questions??

[MaryB & Chester]

From my vet

But in any right, if you feel that for your comfort level you want/need to take the BG before you give insulin, then I would suggest waiting to the BG until about 1 hour after he eats (if your schedule will allow that time difference). Often if you are taking the BG in 30 min or less after he eats, that will be when his BG is on the rise and you might be getting it at a low or lower, point.
I agree with you, I would be concerned about giving him an insulin injection if his BG is < 150. However, if we skip the dose totally then we often get a rebound effect in the BG value and the next value is often quite high.
What I would suggest, is that if he ate his full meal, and you have taken the BG at least an hour after eating and is still < 150 would be to perhaps skip that dose or give a 1/2 dose. That way we can likely prevent both rebound hyperglycemia or significant hypoglycemia. If you find that you have to consistently skip doses, that may be an indication for dose adjustment.

But around here, the protocol is test/feed/shot or test/shot/feed. We don't test AFTER eating because (as I understand it) the food can (somewhat) artificially increase BG beyond what they would "normally" be. My vet says to feed, wait an hour, then test and shoot.
I'm getting confused again...

I ask because Chester is giving me more incidences of BG <= 150. I know some people shoot numbers like this all the time, but it makes me really nervous. I can't always stay home or stay up all night to make sure he's safe. If I don't give him his shot, I'm greeted by something >400 next test around. I don't want to jump his dose around because that's not how Lantus works. But i don't want to skip a bunch of shots and keep him swinging like that.

I feel like I'm asking the same questions over and over again - because I just don't get it.
And my husband gets frustrated that I want to test Chester so often (AMPS, lunch, PMPS, bedtime) and he asks "Why can't you just do what the vet says?"
'Cause I'm not sure that what my vet is telling me is right!

 

[MommaOfMuse]

Re: Shooting low, test/feed or feed/test and other questions

That is old school and was used with NPH because it hits so hard in the beginning they needed food on board before the insulin..with Lantus and Levemir (not sure on PZIs) insulin doesn't even begin to kick in for 2-3 hours after injection. If you are constantly having to skip shots and are not comfortable shooting low to stay low then simply reduce his dose. Yes, it might lessen his chances of remission but there is absolutely nothing wrong with just keeping him tightly regulated and on insulin if that is what it takes to keep him safe and you sane.

Mel, Maxwell, Autumn & The Fur Gang

 

[Carl & Polly & Bob (GA)]

Re: Shooting low, test/feed or feed/test and other questions

From the vet's quote, it sounds like he's not basing the dose on the nadir number? Yes, you need to pay attention to the preshots with Lantus, and it's good to know that the BG isn't dropping at the time you give the shots. But the nadir number is the one that is key to the amount of dosage, not the preshot number.

Tell your DH that the reason that you need to test before the shots is because you want to make sure it is safe to give the shot. And the reason you need to test in the "middle" of the cycle is because that's the number that tells you how low the BG goes, and determines if the dose is too high, too low, or just right.

Carl

 

[MaryB & Chester]

Re: Shooting low, test/feed or feed/test and other questions

We're dosing based on the curves that i run. It's just hard to get a curve when you have to skip doses. And then I finally do get to run a curve, and there are no low numbers to be found. Since we bumped him up to 2.5 units, he's either over 400 or less than 200. Not a lot of anything in between yet.
I wish Chester's "Sugarcat Dance" were less of a Harlem Shake and more of a nice relaxed waltz...