Zoot! Can anyone tell me the BG number when not to shoot Lantus?

From the sticky
http://www.felinediabetes.com/FDMB/...y-to-shoot-handle-lower-pre-shot-numbers.147/


How to Deal with Low Preshot Numbers (the following guidelines apply to those following the Tight Regulation Protocol only):
You just tested your cat’s preshot number, and there is a much lower than usual number staring back at you. What do you do?

There is no one-size-fits all answer, but there are some general guidelines. As with everything else, each cat is different (ECID) and each caregiver is different too.

The short answer is that most kitties can be shot at +12, almost regardless of the number, once you are data ready to do so. The exception is that shooting 30s or 40s is not recommended for most cats, so if a cat is lower then usually the best option is to wait until they are at a shootable number to shoot. What constitutes a shootable number will vary by cat, but we don't suggest or recommend shooting a preshot number less than 50. While you’re waiting, the depot is draining, so you want to get the insulin in as soon as it makes sense to shoot.

If it is your first time shooting green, then we will likely suggest that you stall the first time, even if the number is 80-100. That will let you collect data on what your cat will do when you stall. One thing you can do if you are having a low cycle is to get a +10 and +11. Those will give you a good idea of how quickly the cat’s numbers are rising (or not) when preshot time arrives.

Beyond the general guidelines, there are other factors we consider when we are helping someone with a low preshot.
  • If the low preshot is not part of that cat’s normal pattern or there is reason to think something might be wrong, we will be more conservative.
  • If the cat is not a food spiker or tends to have an early onset/early nadir then they may not want to shoot as low. If the cat has a late nadir, then they will HAVE to learn to shoot low.
  • We will also be more conservative in some cases because of the person – if you are not able to monitor then you want to be more careful, or if you are not sure that you can get back to the board to keep us updated throughout the cycle. Trust me, if you shoot low, we will be watching for your updates and we will worry if we don’t see them.
  • We have to be a lot more careful with the cats who eat only dry food, because they don’t have access to the tools the rest of us use to keep our cats safe.
  • Also, when it comes to very low preshots, there is an unwritten rule that whoever helps that person shoot low should expect to sit with them through any low parts of the cycle. There have been times when I knew a cat’s number was likely shootable, but I also knew that I could not be around to help if the shot resulted in low numbers later in the cycle. For safety’s sake, if I could not find someone else who would be available to support for the next several hours, I would most likely suggest that the shot be reduced or skipped. I will not encourage someone to shoot low and then abandon them.
  • There are a lot of other scenarios, and you always want to keep your cat in mind.
 
What @Sandra And Buddy said about not shooting under 50 is if you choose to follow Tight Regulation (TR) and if you have enough data to feel comfortable shooting lower numbers.

You have shot lower in the past and Zoot is coming up.

But here are the general guidelines for those new to lower PS numbers:

Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
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I'm not familiar with Zoot. Are you following a method? It seems like you're following SLGS though. Good numbers for Zoot today!
 
I read your SS notes just now. Seems like you're working with the vet and switching to AlphaTrak. Are you still using the Relion right now?
 
Okay - so I feel like it was safe to give his dose at 190. We checked him right before dosing and he was 297 - that was within an hour. It could be he is bouncing due to the low numbers/increased dosage. We are thinking best to monitor him, test tonight and be consistent. In any case we dosed him as normal.
 
Crista & Ming said:
What @Sandra And Buddy said about not shooting under 50 is if you choose to follow Tight Regulation (TR) and if you have enough data to feel comfortable shooting lower numbers.

You have shot lower in the past and Zoot is coming up.

But here are the general guidelines for those new to lower PS numbers

I'm not familiar with Zoot. Are you following a method? It seems like you're following SLGS though. Good numbers for Zoot today!
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Oh crap- well we dosed him a full dose, but I will say that he was 297 right before dosing, so maybe we are okay. I will check him at +1 and +2 to see how he is doing.
 
Thanks to all for all the help. Zoot does generally have good numbers even at higher numbers, but having low numbers is, frankly, scary, because he has been in yellow and pink for so long!
 
Cinnie Cole said:
Oh crap- well we dosed him a full dose, but I will say that he was 297 right before dosing, so maybe we are okay. I will check him at +1 and +2 to see how he is doing.
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I would've advised you to give the full dose anyway :) Good job! Zoot may be bouncing from the nice green he saw today.

Cinnie Cole said:
Long story but we just changed vets because we could not get on the same page with our prior vet. We have yet to figure out which protocol we will follow.
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I'm not saying don't work with your vet, but many of us go to our vets for all things unrelated to diabetes. It's difficult to juggle vet advice with the advice here as they're not often seen eye to eye. In the end, it is your choice and it's up to you what you're comfortable doing for Zoot.

But I always vote to follow those here at FDMB. Many of us live and breathe diabetes and the collective knowledge gathered here has been so valuable to me -- even life saving. While vets only have the opportunity to see a snapshot of the lives of a diabetic cat and the caregiver. We don't do things "just because" but follow protocols (The TR protocol is published in a journal of veterinary medicine) so everything here is done safely and methodically. I encourage you to take a peek at other people's threads and see what's going on around the Lantus board. You'll learn lots :D
 
I want to tweek some of the information. The issue of a "don't shoot' number isn't entirely accurate. With someone who is new to FD, we suggest that if you're following TR, to post and ask for help if numbers are at 150 or less. With SLGS, you post and ask for help if numbers are 200 or below. As there are several options available, someone who had dealt with this situation can walk you through the possibilities and help you figure out what is best given the current situation.

When you do not shoot is if numbers are below the dose reduction threshold. You don't shoot below 50 with TR or 90 with SLGS.
 
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Sienne and Gabby (GA) said:
I want to tweet some of the information. The issue of a "don't shoot' number isn't entirely accurate. With someone who is new to FD, we suggest that if you're following TR, to post and ask for help if numbers are at 150 or less. With SLGS, you post and ask for help if numbers are 200 or below. As there are several options available, someone who had dealt with this situation can walk you through the possibilities and help you figure out what is best given the current situation.

When you do not shoot is if numbers are below the dose reduction threshold. You don't shoot below 50 with TR or 90 with SLGS.
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Thanks. We still need to figure out TR versus SLGS or if we want to rely on our Vet. Right now in our household we are struggling with this decision. I should have just enjoyed the day of blue and green instead of freaking out.
 
If it's any consolation, everyone wants their cat in good numbers and pretty much everyone freaks out when it happens. You're in good company!
 
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