2/25 EMMY AMPS 283 +10 59 PMPS 122 - Newbie needs dosing advice

Hi,

I know that I should give Emmy's dose (3u, Lantus) but I am still new and nervous. She does not do well at all unless at 3u but she has had two days where she dipped as low as the 50s. She has been high all week as we are adjusting the dose back up to 3 from 2.5u (You can see from her SS she doesn't really move on 2.5u).

Her vet has given me a "Don't Shoot Number" of 90, so theoretically 122 should be fine (I'm talking myself into this) but I cannot stay up all night tonight to monitor her. I can test all night Thursday night. Should I go ahead and shoot tonight? I need some confidence!

Thanks for any advice.

 

I would adjust your subject line to include Emmy's name after the date and then after all your numbers DOSING ADVICE NEEDED

or something like that, it will draw people's attention and get you the advice you need I am horrible at interpreting spreadsheets otherwise I would try to help

 

Got it. Thanks ;-)

 

Since Emmy is newly diagnosed we would take a.25 reduction if she goes under 50. I don't give dosing advice but I wonder if she is getting too much insulin. If you can't be up to watch her and test I would not shoot 3 units. I hope one of the pros comes on to advise you. are you stalling and not feeding?

 

well . . . you can see the 3.0u is getting her into the 50's. I'm not sure what you're going to do, though, because if you want the good numbers that the 3.0u brings, you're likely to run into this decision every evening. If you can't monitor her, you probably don't want to shoot 3.0u.

I can't stay with you tonight, either, and our tradition is that if someone encourages you to shoot, they stay with you.

Your choices are to shoot the full dose (and monitor).
Shoot a reduced dose
Skip the shot.

I wouldn't encourage you to skip the shot, but there is never any way of being sure what will happen after you shoot.

The Shooting and Handling Low Numbers sticky says this about your choices:

HOW TO DEAL WITH LOW PRESHOT NUMBERS
**** The following guidelines apply to the Tight Regulation Protocol for Lantus or Levemir ****

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 the cat is less than 50 then usually the best option is to wait until they are above 50 to shoot. While you’re waiting, the shed 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.

Some general rules when stalling (ECID):

** 50s or higher – don’t feed. The number will bump up on its own soon due to the insulin wearing off.
** 40s or lower – you have a couple of choices.

• When 40’s occur at the end of the cycle, it can be beneficial to withhold food and test in 15-20 minutes to determine if kitty is on the rise or hasn’t reached nadir yet.
• If they are hanging in the 40s for a while, or if they are still dropping, it is ok to feed a tsp or two of LC and retest. This is very tricky. You want to avoid feeding too much while you’re waiting for them to go over 50, because you don’t want to artificially inflate the number with food.
• --- Example: if kitty is 43 and you feed a whole meal, or feed some HC, and the number bumps up to 52, is that the cat’s natural end-of-cycle rise, or is it food spike? What if it is food spike? Then if you shoot the 52, when the food wears off he might drop back to the 40’s (and when insulin kicks in a couple of hours later, you might have a problem). If the 52 is the cat’s natural rise, then he will probably keep rising for the next few hours until insulin kicks in. If you can’t tell whether the number is food spike or natural rise, it’s safest to wait. Your data will help you here. Study the spreadsheet. How much food spike does the cat usually get? How many hours after the shot does the insulin’s onset usually occur in this cat? At what number is the cat likely to be when onset occurs? If the cat does drop, how easy/hard is it to regain control of the numbers? How carb sensitive is he?

** Test often (every 15-20 minutes, or at most every 30 minutes). You want to catch the rise the minute it starts. With most of our cats, once they start to rise they will really zoom. You want to get the insulin in as soon as possible, because it will be another 2-3 hours before the insulin kicks in and you don’t want to let the cycle get too far ahead of you.

Perhaps the most important guideline in shooting low is that any time you shoot your lowest ever number, you should get a +1 and +2 to give you an idea of how the cycle will go. If the +1 is not higher than PS, or if +2 is much lower than PS, that means “pay attention” over the next few hours. Those tests will also help you become even more data ready for the next time you are presented with a low preshot reading.

Using the overlap by shooting low is a great way to take advantage of Lantus/Levemir’s long, flat cycles, once you have learned to do so safely.

~ written by Libby and Lucy​

 

Thanks to all. I am skipping the shot tonight. Will monitor closely the evening watch tomorrow. I will give her 3u in morning. I can't shoot later than 7 tomorrow morning so there's no point in shooting tonight - I won't be able to get back on a 12 hour schedule in a short time.

We are not doing the tight regulation but she does seem to have a late nadir so I will have to learn to shoot low sooner or later. Thanks again.

Judy & Emmy

 

good luck, judy!

We have lots of good info on the plusses of shooting normal numbers (50-120) and the positive outcomes that typically happen. But you can't do it without monitoring.

Here is some info for you to read. On this post, "Where Can I Find?" look at the "Shooting & Handling Low Numbers" sticky in the top half of the post, including the part on becoming data ready.

Same link, in the "interesting posts from the past" section, there are 2 posts that you could read. One is called "Shooting Low" and the other is called "Tight Regulation Protocol: Myths Debunked." There's a post in that one called "Shooting a dropping number" that addresses shooting low (which means shooting the full dose into normal numbers.)

Take a look at those 3 items, including looking at the spreadsheets that are referenced. They might help you understand a little more about how Lantus works. When you've taken a look, ask lots of questions and look at the daily posters here and see what's happened when they shoot lower numbers. Particularly notice how the cycles flatten out - it's pretty amazing.

 

Thanks very much Julie! The "interesting posts from the past" were especially helpful. Emmy's nadir looks like it is very late in her cycle so that is what giving me heartburn. Now that I understand more about her BG climbing when the insulin will kick in, I will be less nervous about shooting low.

I am unexpectedly home today so I'm going to try to go for a 24 hour curve. If the poor kid's ear tips last that long.

Thank you again, I have been really struggling to understand how and when the Lantus affects her BG.

Judy&Emmy

 

Like others will probably mention, if your ultimate goal is to try to get Emmy to the Falls (remission off insulin) then you will have to test and will have to shot lower numbers. Remission is not always possible for all cats, but it is very possible for newly diagnosed. I believe the statistic is about 85% of cats treated with the Tight Regulation Protocol with in 6 months of diagnosis go into remission. You will have to check out the Tight Regulation Protocol Sticky for exact numbers.

If your goal is just to get Emmy to comfortable numbers and treat with insulin for the rest of her life than you have a bit more leeway, I don't know anything about this sort of approach so you will have to ask someone else for advice with that.

I can tell you from experience it is VERY scary to shoot low numbers at first, but if you check out Sami's Spreadsheet, both current and when he was on insulin back in 2010, I got confident that I could shot numbers as low as in the mid-upper 50's. BUT, if you are going to shoot numbers this low, you have to have the data to know how your cat will react to food and insulin, and you have to be able to TEST OFTEN.

I can also tell you that numbers in the 50's are not always low for a cat. When Sami went OTJ back in 2010 there were times that I tested and he was as low as 45 and he wasn't even getting insulin. So this could be his NORMAL. I was really concerned about numbers being too low so I tested one of my other non-diabetic cats and often get numbers below 60. When you are using a human meter to test cat blood there is a variance.

I hope this helps you gain confidence in sticking with a dose that helps bring Emmy to good numbers. I don't have specific dosing advice, because I am sort of basket case and get over emotional when it comes to making a decision about what dose I should go with, so I rely heavily on the suggestions of the experts here on this group. Sometimes I do have to go with my gut, but usually that bites me in the end.

Good Luck, I look forward to watching your progress to the Falls.