What do you do when you test before a shot & get a much lowe
- Thread starter Ian & Oz
- Start date
- Status
BJM
Member Since 2010
Re: What do you do when you test before a shot & get a much
Stall - wait 30 minutes without feeding and re-test.
- Report the numbers here if still not over 200 mg/dL for new insulin users.
- If rising and over 200 mg/dL, shoot.
But!
This presupposes you have mid-cycle test numbers showing how low your cat is going. If you don't know how low your cat is going from numerous mid-cycle tests, you might need to back off the dose.
Also, a possible consequence of going much lower than usual, or having the glucose drop quickly, can be a bounce where compensatory hormones kick in and release stored glucose (glycogen). This may result in higher numbers for roughly 3 days.
Stall - wait 30 minutes without feeding and re-test.
- Report the numbers here if still not over 200 mg/dL for new insulin users.
- If rising and over 200 mg/dL, shoot.
But!
This presupposes you have mid-cycle test numbers showing how low your cat is going. If you don't know how low your cat is going from numerous mid-cycle tests, you might need to back off the dose.
Also, a possible consequence of going much lower than usual, or having the glucose drop quickly, can be a bounce where compensatory hormones kick in and release stored glucose (glycogen). This may result in higher numbers for roughly 3 days.
Ian & Oz
Member Since 2014
Re: What do you do when you test before a shot & get a much
BJM,
Since Oz's level dropped to 162 last night, is it possible that it's from 5 days at the new dose of 1.75u?
We tested him 3 times in a row & had 154,167 & 162 readings last night. You say that when the level drops low the body
gives extra insulin & causes the bounce, so can we keep giving him his 1.75 dose?
Ian
BJM,
Since Oz's level dropped to 162 last night, is it possible that it's from 5 days at the new dose of 1.75u?
We tested him 3 times in a row & had 154,167 & 162 readings last night. You say that when the level drops low the body
gives extra insulin & causes the bounce, so can we keep giving him his 1.75 dose?
Ian
BJM
Member Since 2010
Re: What do you do when you test before a shot & get a much
I think I would stick with 1.5 for 3-5 days and get more mid-cycle numbers on it. Some of the numbers you have seen since increasing him have jumped around a bit, which could be bouncing, or could be a response to actually going too low. You don't have much mid-cycle data on the 1.5 dose and appear to have increased based on pre-shot numbers. Lantus doses may be decreased on pre-shots; increases, however, require several tests at mid-cycle around the probably nadir, or lowest glucose level.
I think I would stick with 1.5 for 3-5 days and get more mid-cycle numbers on it. Some of the numbers you have seen since increasing him have jumped around a bit, which could be bouncing, or could be a response to actually going too low. You don't have much mid-cycle data on the 1.5 dose and appear to have increased based on pre-shot numbers. Lantus doses may be decreased on pre-shots; increases, however, require several tests at mid-cycle around the probably nadir, or lowest glucose level.
Ian & Oz
Member Since 2014
Re: What do you do when you test before a shot & get a much
Hi BJM,
Thank You
Ian
Hi BJM,
When you say a response to actually going too low, do you mean dangerously low or just lower than his sytem is used to which causes the bounce? I'm trying to learn & understand "bouncing", you said could be bouncing or going too low, but isn't bouncing caused by going too low? I want to get him to a safe level but am so worried about getting in a dangerously low level. I won't rush things for his safety but there seems to be so many factors, I'm desparately trying to understand all of this.
Thank You
Ian
BJM
Member Since 2010
Re: What do you do when you test before a shot & get a much
Bounces can happen from real lows as well as from just much lower than usual or from dropping rapidly. Or a combination of factors. It doesn't really matter why; you just need to know to wait them out and not increase the dose.
Ex
Glucose test of 40 and you intervened with high carb food (keep some on hand for that purpose); next day or so, tests in the 300s or higher -> these are likely due to a near hypo, plus an unaccustomed low. If you tested several times from +2 hours to nadir, you might have seen a rapid drop or not.
Bounces can happen from real lows as well as from just much lower than usual or from dropping rapidly. Or a combination of factors. It doesn't really matter why; you just need to know to wait them out and not increase the dose.
Ex
Glucose test of 40 and you intervened with high carb food (keep some on hand for that purpose); next day or so, tests in the 300s or higher -> these are likely due to a near hypo, plus an unaccustomed low. If you tested several times from +2 hours to nadir, you might have seen a rapid drop or not.
Shelly & Jersey (GA)
Member Since 2014
Re: What do you do when you test before a shot & get a much
Hi Ian,
Bouncing can be caused from several different things:
What's difficult for us right now is that there isn't quite enough data yet for us to be able to tell what's happening with Oz. Getting the mid-cycle tests will tell us if Oz is bouncing from numbers that are too low, numbers that are lower than he's used to seeing, numbers that have fallen quickly, etc.......Thanks for getting those mid-cycle tests in the past couple of days. That really does help.
It usually takes up to 6 cycles for a bounce to clear, although every cat is different. If Oz is bouncing from lower numbers (like in the AM of 10/3), the bounce should clear in the next cycle or two.
Hope that helps!
Shelly
Hi Ian,
Bouncing can be caused from several different things:
- 1. Dropping too low: If a kitty drops into hypoglycemia "territory" (e.g., under 40-50), his body will try to release extra glucose to bring those numbers back up into a safe range.
2. Dropping lower than the kitty is used to: Keep in mind that Oz has probably had numbers in the 200s and 300s for quite a while. His body now sees the 200s and 300s as "normal." If he drops lower than that now, his body may think he is going too low and release extra glucose. For instance, let's say Oz went down to 150 on a dose. Although that's not too low in terms of hypoglycemia, it's lower than Oz is used to. His liver panics and releases extra glucose to bring the numbers back up.
3. Dropping fast: Any time the blood sugar levels go down quickly, that can cause a bounce, too. For example, let's say that Oz started at 300 at shot time and dropped down to 200 just an hour or so later. That fast drop (e.g., 100 points in an hour) might cause his liver to panic and release extra glucose, too.
What's difficult for us right now is that there isn't quite enough data yet for us to be able to tell what's happening with Oz. Getting the mid-cycle tests will tell us if Oz is bouncing from numbers that are too low, numbers that are lower than he's used to seeing, numbers that have fallen quickly, etc.......Thanks for getting those mid-cycle tests in the past couple of days. That really does help.
It usually takes up to 6 cycles for a bounce to clear, although every cat is different. If Oz is bouncing from lower numbers (like in the AM of 10/3), the bounce should clear in the next cycle or two.
Hope that helps!
Shelly
Ian & Oz
Member Since 2014
Re: What do you do when you test before a shot & get a much
Hi Shelly,
Thank you for the explanation, still confusing with all of the different things that can cause a bounce.
Can dropping his insulin dose like we did from 1.75u to 1.5u cause a bounce also?
He's still going up & down, I've taken a few extra readings today & will try to get a few more.
I know that the key will be finding his "common" low level for that dose, it just seems that he's constantly bouncing or maybe not, really confusing.
Thank You
Ian
Hi Shelly,
Thank you for the explanation, still confusing with all of the different things that can cause a bounce.
Can dropping his insulin dose like we did from 1.75u to 1.5u cause a bounce also?
He's still going up & down, I've taken a few extra readings today & will try to get a few more.
I know that the key will be finding his "common" low level for that dose, it just seems that he's constantly bouncing or maybe not, really confusing.
Thank You
Ian
BJM
Member Since 2010
Re: What do you do when you test before a shot & get a much
If the glucose is still dropping quickly and/or to an unaccustomed number, then yes.
And sometimes, the numbers are wonky because they're wonky. Diabetes is a multifactorial condition where numerous things may affect the glucose level - food batches, activity levels, other medical conditions, stress, and more.
If the glucose is still dropping quickly and/or to an unaccustomed number, then yes.
And sometimes, the numbers are wonky because they're wonky. Diabetes is a multifactorial condition where numerous things may affect the glucose level - food batches, activity levels, other medical conditions, stress, and more.
Re: What do you do when you test before a shot & get a much
The act of changing a dose from 1.75 to 1.5 units will not by itself cause a bounce. You may see higher numbers if the lower dose is not enough insulin, or if you lowered the dose because numbers were dropping too low or lower than what Oz's body is used to. But he's had enough time at the 1.5U dose to get rid of any bounce, which can take up to 6 cycles to clear. If you can continue to get mid cycle tests, you are probably OK to increase back to 1.75 U. It's been the 3 days that BJM suggested. Getting mid cycle tests will help you determine how low the 1.75U dose is taking Oz.
The act of changing a dose from 1.75 to 1.5 units will not by itself cause a bounce. You may see higher numbers if the lower dose is not enough insulin, or if you lowered the dose because numbers were dropping too low or lower than what Oz's body is used to. But he's had enough time at the 1.5U dose to get rid of any bounce, which can take up to 6 cycles to clear. If you can continue to get mid cycle tests, you are probably OK to increase back to 1.75 U. It's been the 3 days that BJM suggested. Getting mid cycle tests will help you determine how low the 1.75U dose is taking Oz.
BJM
Member Since 2010
Re: What do you do when you test before a shot & get a much
Partly, you test out your options and figure out what works for your cats. Mine all gradually graze after an initial chow down. I leave the food out and it lasts roughly 10 hours. Ideally, you pick up the food at +10 so the pre-shot isn't food influenced.
Since food effects often show up around 2 hours after feeding, you might feed 1/3 at shot time and 2/3 at +3 and see how that goes.
Feeding a bit more just before the nadir can "feed the curve" to keep the glucose from going too low which is a technique used in cats who don't hold a dose reduction very well.
Or you might try 1/3 at shot time, 1/3 at +2, and 1/3 at +5.
It can help to have a timed feeder such as the Pet Safe 5. With several cats, you may need a couple of feeders spread around so everyone gets a shot at the food.
ian said:
Partly, you test out your options and figure out what works for your cats. Mine all gradually graze after an initial chow down. I leave the food out and it lasts roughly 10 hours. Ideally, you pick up the food at +10 so the pre-shot isn't food influenced.
Since food effects often show up around 2 hours after feeding, you might feed 1/3 at shot time and 2/3 at +3 and see how that goes.
Feeding a bit more just before the nadir can "feed the curve" to keep the glucose from going too low which is a technique used in cats who don't hold a dose reduction very well.
Or you might try 1/3 at shot time, 1/3 at +2, and 1/3 at +5.
It can help to have a timed feeder such as the Pet Safe 5. With several cats, you may need a couple of feeders spread around so everyone gets a shot at the food.
Shelly & Jersey (GA)
Member Since 2014
Re: What do you do when you test before a shot & get a much
Hi Ian,
I checked Oz's ss this afternoon. That was quite a drop from AMPS this morning to +2. If you can get another test or two in today, I would really recommend it. (I'm not sure how long it's been since you gave the shot this morning.) Any time you see a large drop like that, it's always a good idea to get more tests in if you can; it's an ideal opportunity to see how well the 1.75u is working for Oz!
You've been doing a great job testing the past few days. At this point, you may want to consider moving to one of the insulin-specific support groups on FDMB. We have two of them - "Relaxed Lantus" and "Tight Regulation" or "TR."
The Tight Regulation approach is based on research that was published in a veterinary journal. The research showed that cats who were started on the TR protocol soon after diagnosis had the best chances of going into remission. (Here's a link to to the research: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581. With TR, you really need to be able to test at least four times a day (AMPS, PMPS, and at least one mid-cycle test in the AM and PM). Dosing adjustments are made relatively quickly (e.g., every 3 days), so the mid-cycle testing is important. The "Relaxed Lantus" group follows a lot of the same basic guidelines, but it is based more on a "start low, go slow" approach. For example, members in Relaxed Lantus may hold doses longer than the 3 days recommended by TR.
If you do decide you would like to move to one of the insulin-specific forums, just click on the name of the forum you want to join, and start a new thread. For the subject line, we ask that you put the date, your kitty's name, and the numbers for the day. For instance, your subject line for today might look like this "10/9 Oz AMPS-374, +2-257." As you get new readings in, you can just update the subject line of your post to show your new readings. On TR, we do ask that you start one new thread each day. So....tomorrow, you would start a "10/10 Oz" thread.
If you want to keep posting on this Health board, you certainly can. Moving to one of the insulin support groups, though, can be helpful since a lot more Lantus users will see your posts that way. The TR board is generally much more active than the Relaxed Lantus board; there are simply more members there at various times of the day/night in case you run into trouble or have a question (e.g., like about shooting low).
Do you have any questions about the insulin groups? I was a member of TR, so I'm much more familiar with it than Relaxed Lantus. If you have questions about Relaxed Lantus, though, I'm sure we can find members who can answer them for you!
Shelly
Hi Ian,
I checked Oz's ss this afternoon. That was quite a drop from AMPS this morning to +2. If you can get another test or two in today, I would really recommend it. (I'm not sure how long it's been since you gave the shot this morning.) Any time you see a large drop like that, it's always a good idea to get more tests in if you can; it's an ideal opportunity to see how well the 1.75u is working for Oz!
You've been doing a great job testing the past few days. At this point, you may want to consider moving to one of the insulin-specific support groups on FDMB. We have two of them - "Relaxed Lantus" and "Tight Regulation" or "TR."
The Tight Regulation approach is based on research that was published in a veterinary journal. The research showed that cats who were started on the TR protocol soon after diagnosis had the best chances of going into remission. (Here's a link to to the research: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581. With TR, you really need to be able to test at least four times a day (AMPS, PMPS, and at least one mid-cycle test in the AM and PM). Dosing adjustments are made relatively quickly (e.g., every 3 days), so the mid-cycle testing is important. The "Relaxed Lantus" group follows a lot of the same basic guidelines, but it is based more on a "start low, go slow" approach. For example, members in Relaxed Lantus may hold doses longer than the 3 days recommended by TR.
If you do decide you would like to move to one of the insulin-specific forums, just click on the name of the forum you want to join, and start a new thread. For the subject line, we ask that you put the date, your kitty's name, and the numbers for the day. For instance, your subject line for today might look like this "10/9 Oz AMPS-374, +2-257." As you get new readings in, you can just update the subject line of your post to show your new readings. On TR, we do ask that you start one new thread each day. So....tomorrow, you would start a "10/10 Oz" thread.
If you want to keep posting on this Health board, you certainly can. Moving to one of the insulin support groups, though, can be helpful since a lot more Lantus users will see your posts that way. The TR board is generally much more active than the Relaxed Lantus board; there are simply more members there at various times of the day/night in case you run into trouble or have a question (e.g., like about shooting low).
Do you have any questions about the insulin groups? I was a member of TR, so I'm much more familiar with it than Relaxed Lantus. If you have questions about Relaxed Lantus, though, I'm sure we can find members who can answer them for you!
Shelly
Ian & Oz
Member Since 2014
Re: What do you do when you test before a shot & get a much
Thank you Shelly!
I have some other readings from today +4 =189, +5 = 170 & +8 = 264.
Based on what I'm learning, as long as his 9:00 pm pre shot test tonight is still in the 200's, I should be able to continue his 1.75u dose tonight, I think, because the mid cycle numbers were in the higher 100's & came back up to 264, does sound right?
I'll have a look at those other groups, not sure which way I should go though.
Is it possible to get them off of insulin with the relaxed approach or can it only be done with tight regulation?
Thanks again Shelly!
Ian
Thank you Shelly!
I have some other readings from today +4 =189, +5 = 170 & +8 = 264.
Based on what I'm learning, as long as his 9:00 pm pre shot test tonight is still in the 200's, I should be able to continue his 1.75u dose tonight, I think, because the mid cycle numbers were in the higher 100's & came back up to 264, does sound right?
I'll have a look at those other groups, not sure which way I should go though.
Is it possible to get them off of insulin with the relaxed approach or can it only be done with tight regulation?
Thanks again Shelly!
Ian
Shelly & Jersey (GA)
Member Since 2014
Re: What do you do when you test before a shot & get a much
Glad to see you were able to get a few more checks in today! If you decide you want to follow the Tight Regulation protocol I mentioned, you're going to want to hold the dose for a few more cycles. Here's information from that protocol:
....and....
So....stick with 1.75u through tomorrow (10/10) unless Oz goes below 50, keep getting in mid-cycle tests like you've been doing, and then ask again tomorrow evening about the dose for Saturday (e.g., if you should raise it). We'll get some much more experienced users to look at Oz's numbers and see what they think about the dose at that point. I'm really not comfortable giving much dosing advice - I definitely know the limits of my "expertise." ;-)
If you get a low pre-shot number at any point (e.g., under 200), you can always post and ask for help before you give insulin, too.
Glad to see you were able to get a few more checks in today! If you decide you want to follow the Tight Regulation protocol I mentioned, you're going to want to hold the dose for a few more cycles. Here's information from that protocol:
....and....
So....stick with 1.75u through tomorrow (10/10) unless Oz goes below 50, keep getting in mid-cycle tests like you've been doing, and then ask again tomorrow evening about the dose for Saturday (e.g., if you should raise it). We'll get some much more experienced users to look at Oz's numbers and see what they think about the dose at that point. I'm really not comfortable giving much dosing advice - I definitely know the limits of my "expertise." ;-)
If you get a low pre-shot number at any point (e.g., under 200), you can always post and ask for help before you give insulin, too.
Shelly & Jersey (GA)
Member Since 2014
Re: What do you do when you test before a shot & get a much
Sorry - didn't see your last post before I posted! Hope I answered your question about the dose.
I am, of course, biased because I had such great success with TR and got Jersey into remission with it. ;-) I think 16 TR cats have gone into remission since Jersey did back in April. Cats can certainly go into remission with the relaxed approach, and I've seen several of them go into remission during my time here (although I don't have a specific number).
If you want the best chances of remission, I personally think TR is the way to go. I say that based on my own personal experiences and based on the fact that the TR protocol is research-based. That's just my 2 cents' worth, though. You have to make the decision based on what feels right to you.
Sorry - didn't see your last post before I posted! Hope I answered your question about the dose.
I am, of course, biased because I had such great success with TR and got Jersey into remission with it. ;-) I think 16 TR cats have gone into remission since Jersey did back in April. Cats can certainly go into remission with the relaxed approach, and I've seen several of them go into remission during my time here (although I don't have a specific number).
If you want the best chances of remission, I personally think TR is the way to go. I say that based on my own personal experiences and based on the fact that the TR protocol is research-based. That's just my 2 cents' worth, though. You have to make the decision based on what feels right to you.
BJM
Member Since 2010
Re: What do you do when you test before a shot & get a much
The decision also needs to consider your schedule and costs. If there is no way for you to get mid-cycle tests during the week, only on the weekends, because you're not home in the middle of the day and waking up in the middle of the night to do it just won't work, you may be happier with the Relaxed Lantus forum.
If your cat has other medical conditions which make it difficult for TR to work, you'll want to add that to your signature if it isn't there already - ex. steroids for IBD, asthma, etc. These can require some finagling to control the glucose.
The decision also needs to consider your schedule and costs. If there is no way for you to get mid-cycle tests during the week, only on the weekends, because you're not home in the middle of the day and waking up in the middle of the night to do it just won't work, you may be happier with the Relaxed Lantus forum.
If your cat has other medical conditions which make it difficult for TR to work, you'll want to add that to your signature if it isn't there already - ex. steroids for IBD, asthma, etc. These can require some finagling to control the glucose.
- Status