To shoot or not to shoot

[Sue484]

Hi. After my indecision this morning, I thought I would see if anyone has an idiots guide of when not to shoot. There must be a lower figure where you do not shoot and there must be a figure where you reduce the dose. But by how much? If anyone can help that would be great and save me taking up so much of your time. Can I have the figures in Alphatrak numbers please rather than human. Plus what would have happened in your opinion if I had shot the full dose this morning? Would he have stayed flat and low or dropped too far? Thanks.

 

[Chris/China (GA)/Garfield]

There really isn't any hard and fast rule, but generally, once you have enough data to know how your cat usually responds to food and insulin, we will start suggesting shooting the "scheduled dose" at about 200 (On AlphaTrak) and as you continue to get data, gradually that limit goes lower and lower. Many of us here will shoot anything above 68, but only after we really know our cats.

Lantus works best when it's not being asked to pull down high numbers. I know it seems crazy when you shoot a 400 and it drops them to 150 and then we're telling you to shoot the same dose at 150 (seems like they'd drop to zero, doesn't it?) but it just doesn't work that way

As for what would have happened this morning, there's really just no way to know for sure. Every cat is different and every cycle can be different too, but USUALLY, if you'd shot this morning, he may have stayed in the blues for the whole cycle (but I doubt it since it looks like he's bouncing from the blues last night)

Unfortunately, there's just no easy answer for your questions...generally, if you're able to test and have all the supplies you need, you can shoot almost any number, no matter how low (except under 68)

 

[Sue484]

Thanks. That was exactly what I was fearing. He is on a high dose and then to give him that when he was so low I couldn't get my head around it. My mind is at rest for the minute. I can go out and enjoy myself without worrying of a hypo just because he is bouncing. Plus I'll get a good night's sleep!!! Now comes the hard work to get him back down again...

 

[Sienne and Gabby (GA)]

For someone new to this process, the "no shot" or more accurately stated, "post and ask for help" number varies depending on whether you're following the Tight Regulation Protocol (TRP) or the Start Low Go Slow (SLGS) approach. For the TRP, the number is 150 and for SLGS it's 200.

What we look for regardless of the dosing method is that you are "data ready" (see the Shooting & Handling Low Numbers sticky for more info on becoming data ready.) What this means is that you want to start not only collecting test data that informs you about onset, nadir and duration for your cat so you begin to have a grasp of your cat's patterns, but also that you begin to think about and develop the confidence to shoot progressively lower numbers.

Looking at Frankie's SS, you've shot 151 and 108. Shooting 157 this morning, unless you were going to be leaving immediately should have been easy given your experience.

Beyond that, Chris is right -- there aren't any guidelines for shooting a reduced dose. In part, it can depend on the dose your cat gets, whether your cat is eating, if a bounce is breaking, and probably a dozen or so other things. Since I'll shoot any number above 50, today is a good example for Gabby. Ordinarily shooting an 83 would mean she was going to be surfing in lower green numbers. So far, it looks like she had a very late nadir and her numbers are now (at +2) heading back up. She may still surprise me by heading back down. The only thing that's predictable about our kitties is that they are unpredictable!

 

[julie & punkin (ga)]

Just one more thought to add - it looks like you stalled this morning before you shot. Stalling acts like a dose decrease because the previous Lantus dose is wearing off while you stall. Then if you also shoot a decreased dose, in a way you've given a double-whammy of a reduction.

You may want to consider giving the full dose after you've stalled, or give the reduced dose without stalling. What I mean is choose one or the other, because doing both really reduces the amount of blood sugar control you're going to see after you do shoot.

Once you've seen a lower preshot it's likely you're going to be presented with the occasion again. In the meantime, read the link Sienne gave you above about becoming data ready to shoot low. Also, Andrea just went through this with Tennie last night and you might learn something from reading her yesterday's condo about it.