Dose or don’t dose?

Hi so I just checked Fred’s levels an hour before he is due for his shot as he seemed like he was low and he was a 5. If he stays this low at pmps do you shoot or skip? If he goes up a bit say a 7 or 8 do I shoot a full 3u or a heavily reduced shot like 1u? We are using SLGS method but recently he has been dropping low and staying low so we skip and he bounces up high for the next few doses then comes crashing back down to a low pmps again. Everytime I skip it’s like starting over again so I was hoping not to skip but I don’t want to overdose him either. Is it worth giving him a high carb meal to raise his level for the pmps?

 

Don't feed him before his PMPS test, otherwise you have a preshot which is food influenced.
Test at the PMPS and post what it is.
If you read the SLGS protocol you will see there are guidelines as to when to shoot and when to not shoot.
I will watch for your post at Preshot

 

@alexi456 What did you decide to do about the PM dose?
What was the PMPS BSL?
Looking at Fred's SS, in the last week you have had 4 skipped doses, one dose of 4 units on the first day and doses of 3.5 and 3 units but no run of consecutive doses of the same amounts.
The high numbers in the reds and pinks could be from bounces because of low numbers, or from skipped doses or from a combination of the two. Lantus works best if the same dose is given each 12 hours. If you are having to skip because of low numbers we need to find a dose that allows you to give the insulin each time. Starting tomorrow, if I were you, If he has a safe preshot, I would reduce his dose to 2.5 units and see if that dose allows you to shoot each time.
Are you testing for ketones? When a cat is getting higher numbers it is important that the urine is tested for ketones as they can lead to serious illness if not treated. You can buy a bottle of ketonstix from a chemist for about $12.
Have you decided to go ahead with the continuous BSL monitor that you mentioned in the other thread? I think it would be a very good idea and could give us some good data to see what he is doing during the cycles.

 

Hi sorry we’ve been trying to get a test but can’t get any blood, it’s part of our problem with the testing his ears still don’t bleed everytime sometimes we just punch him full of holes for nothing. We ended up skipping because we couldn’t tell if he was safe or not. He’s only just started to get these low pmps for some reason 3u didn’t shift him at all from the 20s last few times we tried it

 

We test for ketones daily with pee strips

 

The vet is looking into the continuous monitor for us and I think we will end up going that way so we can get consistent data. Fred was heavily abused before we rescued him and he has a lot of scar tissue on his front legs and ears and I’m not sure but that could be why we are having so much issue getting blood

 

Oh, that is so awful to hear!!!! So glad he was rescued and in good hands now!

If he has a lot of scar tissue on his ears, another testing location you can use is the paw pad. If he has a history of abuse, though, he may not let you do that. Poor little guy .

 

That is good

Oh dear, poor Fred. I just don't understand how people can abuse animals. Poor darling, no wonder he hates testing.
We had a rescue dog that had been abused and she was the loveliest dog with people she knew but was very frightened of strangers, especially men with hats on, and this often came across as aggression.
What are the size of the lancets you are using? The best sizes are 26 and 28.
Probably an excellent idea to get the continuous monitor from the vet given the circumstances. You will have a much better chance of regulating him getting good data.

Best to skip if you couldn't get a test result at PMPS and the +11 was 90.
Yesterday when he was given 3 units, he was bouncing from the 135 the night before but today when he was coming off the bounce the 3 units got him down to 90. Because you have been giving 3 units and 3.5 units it is hard to gauge what is the best dose. Lantus needs consistency for the depot to fill and settle.You could well have to go up from 2.5 units but we need to pick a dose that will give you a preshot that you can give insulin with. It will take more than a couple of days for him to settle into a dose but this is the best way to get Fred settled in an effective dose. And with the new monitoring system I am sure Fred will make progress.
Try practising drawing up 2.75 units in a used syringe as the next dose after 2.5 is 2.75 and I know you have not used the smaller increments before.
It is the nadir ...lowest BSL in the cycle......that determines the dose, not the preshot.....although we always have to test before giving the insulin to ensure it is safe to give it.
Please keep posting and asking questions. Fred is a lucky boy to have two caring beans who love him a lot.

ETA did you get the syringes with the 1/2 unit markings? They will make it easier to draw up a dose such as 2.75 units

 

I’m sorry you’re having trouble! I was the same with Baby at first. I filled a small sock with rice- heated it in the microwave. Once it is warm, massage the ear upwards & put the sock on the ear until it’s warm. Also a very thin coating of vasoline will cause the drop of blood to bead up. As time goes on you won’t need to do these steps. The ear will bleed freely.
I’m sorry your babe was abused... bless you for rescuing him!!

 

I'd would also go back over to the Lantus forum with any more questions to do with dosing or issues with BSLs etc as there are many more Lantus users over there than on the main forum.

 

@Bron and Sheba we got a 6.5 pmps tonight and his nadir was 11 +6 is this normal behaviour? It feels like his lowest point from his physical behaviour is +12 we will drop to 2.5 tomorrow and see what happens do you think we should dose anything tonight?

 

Sorry just seeing this.
No I would not give a dose tonight. If you are following the SLGS protocol it says "below8.3(150) don't give insulin if you don't have the data on how your cat will respond to the insulin".
The nadir is the lowest point in the cycle not the midpoint, so his nadir would be the 6.5 (117) at +12. Well done getting the mid cycle BSL today.
His AMPS will probably be high in the morning because you have skipped the shot and he could bounce from the 6.5 (117) but still give the 2.5 units and stick to it for 5 days unless Fred drops too low in which case the dose would be reduced.
Post next time over on the Lantus forum where you will get more people who use Lantus to help you.