What is a good pre-shot number?

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StormysMom

StormysMom

Member Since 2017
We are approaching one month into this new diagnosis and I'm just realizing that I don't really know what the optimal "goal" is. We are currently on day 3 of a new dose (1 unit of lantus once per day) and her +10 to +12 hour numbers look good but then they are higher at the time of her next dose (+24). I know we really need a full curve to find out when the number is starting to come up between +12 and +24, but generally what is an optimal pre-shot number for a kitty who is considered regulated?
 
The number is high at the end of the day because the Lantus has worn off. I recommend that you post on the Lantus forum to get advice from the experts there. I will say that your vet's advice to dose once a day is at odds with standard Lantus protocol here and from other vets. I think there's been discussion of this on your other thread. You might have more success if that 1 u was split into two 0.5 u doses given BID. Even if your kitty is having very long duration with Lantus (maybe what your vet is thinking?) the on/off dosing is messing with the depot action of the Lantus.

I know it's hard to read advice that's counter to what your vet is telling you. I'm saying it, though, because I don't think you're getting the full benefit of Lantus dosing this way.

Re optimal goal:
You're aiming for BGs that stay relatively flat over a 24 hour period in a range that promotes healing of the pancreas and reducing the potential for kidney damage over time. The smaller the fluctuation in BG over 24 hours, the better. With an AlphaTrak meter, you'd want these BGs to be in a min/max range of roughly 90 to 150. It takes time and careful dosing to get there.
 
Yes, the Lantus dosing has already been discussed with me but I'll be following my vets directions through the weekend so I can get some good curve numbers. If the numbers support a twice a day dose, I'm sure he will recommend that. He really is a phenomenal vet. We had a foster cat that lost ALL bladder tone due to a urinary obstruction and he was able to restore him 100% through affordable treatment (and a lot of hard work on our end!). He gets the benefit of the doubt from me and I think if there's a concern with dosing the numbers will argue that point for me. ;) The fact that her numbers are not in the optimal range at +24 makes me tend to agree with the twice a day dose being superior (now that I know what the goal is!)
 
StormysMom said:
Yes, the Lantus dosing has already been discussed with me but I'll be following my vets directions through the weekend so I can get some good curve numbers. If the numbers support a twice a day dose, I'm sure he will recommend that. He really is a phenomenal vet. We had a foster cat that lost ALL bladder tone due to a urinary obstruction and he was able to restore him 100% through affordable treatment (and a lot of hard work on our end!). He gets the benefit of the doubt from me and I think if there's a concern with dosing the numbers will argue that point for me. ;) The fact that her numbers are not in the optimal range at +24 makes me tend to agree with the twice a day dose being superior (now that I know what the goal is!)
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You have to do what you're comfortable with. We can only give an opinion. :)
 
seems to me your cat should be dosed a little less then 1 unit but twice a day. .... but I guess that's up to you and your vet.
 
Y'all are definitely right. I got off work a bit early yesterday so I was able to test at +20 and her numbers were already in the 300s. I *might* break my vet's rule and just beg for forgiveness later by changing her dose on my own. :oops: The one thing he asked of me was to not change the dose on my own and I think he asked that in the best interest of Stormy. From everything I've learned it can be very dangerous for a novice to change a dose when they don't know what they are doing. But her home testing numbers clearly show that the 1 unit once a day dose is failing her somewhere between +12 and +20.
 
StormysMom said:
Y'all are definitely right. I got off work a bit early yesterday so I was able to test at +20 and her numbers were already in the 300s. I *might* break my vet's rule and just beg for forgiveness later by changing her dose on my own. :oops: The one thing he asked of me was to not change the dose on my own and I think he asked that in the best interest of Stormy. From everything I've learned it can be very dangerous for a novice to change a dose when they don't know what they are doing. But her home testing numbers clearly show that the 1 unit once a day dose is failing her somewhere between +12 and +20.
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Absolutely true that it can be dangerous to change a dose when you don't know what you're doing. That's why we work so hard here to learn all we can about how different insulins work and, more importantly, how our kitty responds. That's why we push home testing so strongly. I suspect that vets have too much experience with owners who'll opt for euthanasia at diagnosis or are reluctant to monitor BG at home.
 
StormysMom said:
The one thing he asked of me was to not change the dose on my own and I think he asked that in the best interest of Stormy. From everything I've learned it can be very dangerous for a novice to change a dose when they don't know what they are doing. But her home testing numbers clearly show that the 1 unit once a day dose is failing her somewhere between +12 and +20.
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I am hardly an expert but from what I have learned here is that Lantus & Levemir work best on 12 hour cycles. You aren't changing the 1u/day dose if you shoot 0.5 every 12 hours, I would think that is actually safer. Do your syringes have 1/2 unit markings? There is a Lantus board on here, I would suggest posting in that to see what the pros have to say.
 
Bronx's dad said:
I am hardly an expert but from what I have learned here is that Lantus & Levemir work best on 12 hour cycles. You aren't changing the 1u/day dose if you shoot 0.5 every 12 hours, I would think that is actually safer. Do your syringes have 1/2 unit markings? There is a Lantus board on here, I would suggest posting in that to see what the pros have to say.
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Yes - our vet made sure we got the half unit syringes in anticipation of dose reducations.
 
We just started the 1/2 unit twice a day dosing and her numbers are low again (124 @ pmps). I never thought dosing would be this difficult to figure out! :banghead:
 
I think you will see more steady #s now that she is on a 12hr cycle. If you look at the yellow stickies on top in the Lantus forum, you will see 2 methods many of us follow: SLGS (Start Low, Go Slow) & TR (Tight Regulation) Protocol. Some mid-cycle tests around + 6 & +9 may help show when Stormy nadirs (hits her low for the cycle).
 
Bronx's dad said:
I think you will see more steady #s now that she is on a 12hr cycle. If you look at the yellow stickies on top in the Lantus forum, you will see 2 methods many of us follow: SLGS (Start Low, Go Slow) & TR (Tight Regulation) Protocol. Some mid-cycle tests around + 6 & +9 may help show when Stormy nadirs (hits her low for the cycle).
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Yes, lately we've been trying to do some curves each weekend while we are home to test and get that kind of data. I'm just frustrated to have to skip a shot tonight because of low numbers. I know she'll be super high by morning!
 
StormysMom said:
Yes, lately we've been trying to do some curves each weekend while we are home to test and get that kind of data. I'm just frustrated to have to skip a shot tonight because of low numbers. I know she'll be super high by morning!
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There are some pros over in the Lantus board who can guide you on skipping shots or not. But I would guess you wouldn't get much sleep if you did shoot & then have to do some testing overnight, and most kitties get lower #s overnight than they do during the day. Do you have a hypo toolbox? Here is a good start: http://www.felinediabetes.com/FDMB/threads/jojo-and-bunnys-hypo-tool-box.2354/
 
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Yeah, I don't like to shoot anytime she's near 100 b/c I'm terrified of a hypo! Plus we don't have good data on her nadir. But we do have what's needed to treat a hypo -- and an emergency vet right around the corner!
 
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