Hi there ! I can see your hesitancy in shooting that number for sure. They typically don't recommend shooting a number less than 150 with SLGS in the beginning I believe. Often if you need help fast, you can click on THREAD TOOLS to the right and the EDIT TITLE and add the "?" from the drop down menu so folks know you are still waiting on an answer.
If you can, I would still grab a +1 or +2 so that you have data to show what happens when you skip.
Often a +10 or + 11 can tell you if you are "safer" to shoot a number in the future. On the 17th according to your SS, Clarence was at (324) for his +10 and then higher for the PMPS number. So, you can see that he is usually on his way up for the PS. Sometimes, if you grab a +1 after giving the dose, you can see that they continue to rise ever after the shot time. Although, since you just switched to Lantus I am not sure at what point you would be able to see this in your own dosing.
Example of an ACTIVE, but NOT necessarily typical Lantus/Basaglar cycle:
NOTE: Until kitty is pretty well regulated, the description below is NOT not what you'd consider a "typical" Lantus/Basaglar cycle.
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number. Onset begins around +2 for most cats. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing!
+3 - Often lower than the PreShot number.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Basaglar/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.
So, I try to grab some +10 and a few +1 - just so I know which way my guy is going when I get Preshot number that looks off.
Here is the link to that section concerning the 12 hours schedule and how to handle low Preshot numbers in the future. It can be a lot in a short amount of time to digest and read- but for me when I first got here having the info to refer back to helped me not panic.
I work 12 hour shifts and often have to shoot late. I was told that within 30 minutes for a 12 hour period- is fine. So if you have to shoot 45 minutes late, you would need to adjust by 15 minutes ( back) to get yourself back on schedule, but with Lantus you can shoot at 11.5 and be okay.
Shooting schedule / stalling
http://www.felinediabetes.com/FDMB/threads/getting-back-on-a-12-12-shot-schedule.101059/
Lower PS numbers
How to handle a lower than normal preshot number:
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.
Keep in mind these are general guidelines, and
they should be personalized to your own cat's response to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.
With experience, you may find that lowering these thresholds may work well for your cat. When you have reached that stage, the following guidelines are suggested for Lantus, Basaglar, and Levemir users following the Start Low Go Slow approach:
If the preshot number is far below usual preshot numbers:
- Do you need to stay on schedule? Then skip the shot.
- Do you have some flexibility with your schedule? Then stalling to wait for the number to rise might be a good option. Don't feed, retest after 30-60 minutes, and decide if the number is shootable.
- Repeat until the cat either reaches a number at which you are comfortable shooting, or enough time has passed that skipping the shot is necessary.
If the preshot number is near kitty's usual preshot numbers:
Look at your data to see what numbers you have shot in the past and decide what would be a safe, shootable number for your cat. Don't feed. Stall until kitty reaches the preshot number you've decided on and then shoot.
We usually don't suggest or recommend shooting a preshot number less than 90 mg/dL when following the SLGS Method. Remember that with SLGS, generally speaking, your goal is to achieve flat numbers that are greater than 90 mg/dL. However, let experience, data collected, knowledge of your cat, and availability to monitor help in making the best decisions for your cat.
