To give or not to give...

[Simba the ging]

Hi guys,
Me again... so Simba has been home from the emergency vets office for 5 days now, after being in remission since Dec 2018 and turning DKA which lead him to need emergency treatment for 4 days. The vet told me NOT to give his 2 units of lantus if he's at 15mmol or lower, as it's more risky/higher chance of him going hypoglycemic/hyperglycemic easily. So he's only had 1 day(yesterday) where he's gotten 2U x 2 - every other day he's only gotten it once as he was too "low" to give the insulin to.
I feed at 6&6 and give insulin at 7&7, this morning before food he was at 7.6mmol and he was at 14.1mmol an hour after breakfast, so no insulin was given - checked an him.an hour later (830am) and he was at 17.3mmol.....
So I guess my question is; do I give insulin an hour past when he's supposed to have it if he goes up over 15mmol or do I just monitor him throughout the day and if he's above 15mmol come 7pm, give him his insulin dose? Right now, he's trending throughout the day anywhere between 4-18mmol and up until yesterday was only high enough to give insulin in the pm...
I really don't know what to do D:
just when I think I'm starting to get the hang of things, I'm super overwhelmed and over thinking everything

 

[Nan & Amber (GA)]

So, you're only an hour late right now? If you don't mind getting off-schedule I would shoot.

Reasoning: insulin is critical after a DKA, you really don't want to skip if it's at all possible to shoot. I think your vet is being too conservative in the recommendation of 15 as a cutoff (more in next message after I catch up with Simba's story).

 

[Simba the ging]

So, you're only an hour late right now? If you don't mind getting off-schedule I would shoot.

Reasoning: insulin is critical after a DKA, you really don't want to skip if it's at all possible to shoot. I think your vet is being too conservative in the recommendation of 15 as a cutoff (more in next message after I catch up with Simba's story).

The only problem with changing his times is 8&8 doesn't work with my work schedule... like at all, and I was never sure on how to go about switching times insulin is given, I've always been told/read that it's important to stay consistent and make changes in moderation but carefully...

 

[Nan & Amber (GA)]

OK, more now: first, I just double-checked on Canada, and it looks like you guys are changing clocks tonight, so that means that you will only (by the clock time) be off-schedule for this shot and tonight's. If you shoot now, you would shoot again in 12hrs, and then 12hrs later again in the morning you should be pretty close to your preferred time in "clock time". So that makes it even less of a problem to shoot late this morning!

Second thing, in terms of your strategy, is there any way to shift your feeding schedule so that you feed after you do the pre-shot test? Again, you can use the upcoming time change to help-- you'll be feeding later by the clock, but not by Simba's stomach-time (and as we all know, cats are excellent timekeepers for meals!). If you don't want to have to do everything all at once, one option might be to shift the pre-shot test and meal to 6:30, then shoot as usual at 7.

The reasoning: testing before feeding means you have a very clear view of where his BG is, without any possible inflation from the food. This means that you can be more confident in shooting numbers lower than 15mmol/L.

We usually tell new people to use caution if they get a pre-shot number below 11mmol/L, but even then, and especially so soon after DKA, it might still be possible to shoot safely. The procedure is to "stall": very similiar to what you did this morning except don't feed, wait 20-30mins, then test again.

[posting quickly as I wrote something relevant to your post #3, wrt the time change]

 

[Nan & Amber (GA)]

Oh no... I messed up some of what I said about the time change (I knew I would).

I was right (I think) about the shots-- if you shoot at 8pm tonight, 12hrs later it will only be 7am ("Fall back"). But: if you switch Simba's meal times to be a half-hour later, you have this situation:

6pm dinner tonight (clock says 6, Simba-stomach says it's 6: perfect!)
6:30am tomorrow (clock says 6:30, but Simba-stomach says it's 7:30. Uh-oh!!!!)

So, all I said about it being a good idea to try to shift things around so that you test before feeding is still true. But depending on how Simba deals with late meals to begin with, you've already got the 1hr time change on your hands, might not be the best time to try shifting his meals even later!