Gave shot even though lower than normal preshot

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by kurikitty, Feb 19, 2019.

  1. kurikitty

    kurikitty Member

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    Jan 28, 2019
    (Sorry, this is a re-post from the Health forum, but I wanted to see if I'd have luck in getting a faster answer here.)

    So my cat's usual preshot numbers are 252+. Tonight he was at 207 and I remember reading the insulin directions that if he is under 200 then don't give the shot, so I thought it would be ok. But I started to think and look at his last curve, after having a shot, he dropped 163 points at +5. Now I am very scared that he might drop too much tonight so I am going to stay awake to test him. He is on Lantus, 0.5u, and has been for a little over a week.

    Do you guys think he will be ok or should I start taking precautions now to raise his bg?

    I just tested him 2 hours later and it is at 182.
     
  2. billysmom (GA)

    billysmom (GA) Member

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    Feb 26, 2015
    Hello, I'm Lisa. I never had to dose my kitty so I'm not the best person to help here but the forum is quiet tonight. Hopefully someone more experienced will come on to help. I have watched quite a bit though and I've noticed that a cat's response to insulin can vary so it may be fine. How long ago did you give insulin?
     
  3. Crista & Ming

    Crista & Ming Well-Known Member

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    Jun 10, 2018
    Keep testing. 207 can be a safe number to shoot but can definitely be scary the first time shooting a number you've never shot.

    I think it's good that you shot and that you can gather data so that next time, you will feel confident.

    If you find yourself shooting a "low" number again, get a +1 and +2 to see how kitty is doing.

    Also keep in mind: kitties tend to go lower at night.

    What is Grey's BG now?
     
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  4. billysmom (GA)

    billysmom (GA) Member

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    Feb 26, 2015
    Take a +3 and post here. I think you're close to the +3 right?
     
  5. billysmom (GA)

    billysmom (GA) Member

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  6. Crista & Ming

    Crista & Ming Well-Known Member

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    Jun 10, 2018
    I'm no expert either, especially with SLGS but I've had some experience with dealing with low numbers :)

    Hoping someone in the morning will come along and offer better advice!
     
  7. Bear & Lora

    Bear & Lora Well-Known Member

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    Sep 24, 2018
    I PM'd @Bron and Sheba which has helped me twice in the wee hours.
    Hopefully we can get some more members. :)
     
  8. billysmom (GA)

    billysmom (GA) Member

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  9. Bear & Lora

    Bear & Lora Well-Known Member

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    Sep 24, 2018
    So kurkitty while we are waiting, do you have any medium carb (MC) or high carb (HC) in your kitty pantry?
     
  10. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Hi @kurikitty
    Keep testing every hour for the next few hours to see how much Grey drops. Post all the BSLs you take on here please and update the SS as you go..thanks. He is perfectly safe at the moment.
    As Lora asked, do you have some medium and high carb food at home in case you need it?
    He will probably be fine. Just because the BSL drops 163 points in one cycle it doesn't necessarily mean it will drop that much when the preshot is lower. Often as the preshot is lower the curves are flatter .....that is the beauty of Lantus. Getting lots of data will tell you how he reacts to the insulin.
    But it is understandable you are concerned..... and we will help you keep Grey safe if needs be.
    Bron
     
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  11. kurikitty

    kurikitty Member

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    Jan 28, 2019
    Thank you everyone! I just tested him again and he is at 211. I have to work early in the morn, but I set my alarm for every 2 hours to check him. I'll keep updating the spreadsheet.
     
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  12. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

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    Dec 31, 2009
    Keep in mind Lantus is slow acting. The preshot number is not what you are shooting at. You are shooting at a number 2-3 hours down the road, when onset occurs. :cool:
     
  13. kurikitty

    kurikitty Member

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    Jan 28, 2019
    I was scared because of how much he had dropped before after giving him the Lantus. His numbers are always a roller coaster.
     
  14. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    It is understandable to be scared early on in this journey when everything is so new. It is better to be safe than sorry too, so please don't feel you need to explain yourself. It is always best to err on the side of caution and ask lots of questions as this is a steep learning curve.
    That is a good idea to set the alarm and check in 2 hours. Post the result and I will watch for it.
    Next time you shoot a lower number, get a +1 and a +2 as that will often tell you if it is going to be an active cycle and/or if you need to take action early in the cycle. Always post and ask for help if you are unsure. We are happy to help.
    Grey is lucky to have such a caring Mama:)
    Bron
     
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  15. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    As @Sandy and Black Kitty mentioned, try and get some tests in in the pm cycle. Cats often drop lower overnight. Try and always get a before bed test in to see if Grey is likely to drop low overnight. If the BSL is the same or lower than the preshot, then Grey could be having an active cycle and it would be worth while setting the alarm to test him again a couple of hours later.
     
  16. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

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    Dec 31, 2009
    Start collecting data on the overnights. As it stands you are missing half the picture.

    For safety it’s a good idea grab a ‘before bed’ test each night. Then focus on getting spot checks at random times- for example a+3 one night, a +6 another night, a +11 another night etc. In a week or so a more complete picture will start to develop; one that gives you a feel for when onset and nadir occur and also what kind of duration your kitty is getting.
     
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  17. kurikitty

    kurikitty Member

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    Jan 28, 2019
    I get him at 10:30 pm every night before bed. Right now his bg is 224, so I think he will be fine. :) Tired mommy is going to sleep now. Thank you all so much! I'm so grateful for this forum and the awesome people that come here to volunteer their time to help. Sweet dreams all when you sleep.
     
  18. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Looks like he is safe.
    If you get a test each night make sure you put it in the SS for us to see please.
    Sleep well. You got good data tonight
     
  19. kurikitty

    kurikitty Member

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    Jan 28, 2019
    491 this morning :( maybe the shot actually missed even though it went down a bit?
     
  20. Bear & Lora

    Bear & Lora Well-Known Member

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    Sep 24, 2018
    Bear did something similar yesterday AM.
    He went a little lower at onset +2 to +3 then his BG rose, which was a bounce in his case.
     
  21. Bear & Lora

    Bear & Lora Well-Known Member

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    Sep 24, 2018
    That was a lovely curve you did Saturday.
    As time goes on and you are able to get more tests intermittently you will have a better idea of how Grey reacts.
    I can remember how overwhelming and stressed out I was in the beginning which wasn't that long ago.

    I was fortunate in a way.
    I gave up my job in order to take care of my mother who has multiple health issues, which gave me much more time to test Bear.
    I was on FDMB every spare minute trying to cram as much into my brain as possible. :banghead:

    The anxiety you feel will lesson as you learn more. :)
    .
    Beat wishes for a great day and a peaceful night for you both.
     
  22. kurikitty

    kurikitty Member

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    Jan 28, 2019
    Today is definitely the most overwhelming. I feel like I am trying to play doctor and that I am making things worse. :( It is not an easy thing to do, that's for sure.

    Thank you for your kind words. <3 So do you think that Grey had a bounce as well?
     
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  23. Bear & Lora

    Bear & Lora Well-Known Member

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    Since you had doubts that you missed and his BG went down at onset, makes it a good probability that he is having a bounce.
     
  24. Bear & Lora

    Bear & Lora Well-Known Member

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    Sep 24, 2018
    A test after you get home from work and one at AM +11 will give you some good info, but you still have to test at +12 preshot too.
    I just learned from a veteran member Marje and Gracie how important it is to get either a +10 or +11 to determine if a bounce is breaking but you need to have at least one test in between AM preshot and +10 or +11.
    That info can give other experienced members insight in order to help you, if needed.
     
  25. Bear & Lora

    Bear & Lora Well-Known Member

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    Sep 24, 2018
    You are doing a wonderful job!
    You are doing at home testing which is the best thing you can do for Grey.
    As said many times before on the forum: If you had a baby or child with diabetes would you give him insulin without testing and knowing it was safe to do so?
    You are being a great mom to Grey! :bighug:
     
  26. Mphair84

    Mphair84 Member

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    Dec 31, 2018
    So I find this thread interesting, and helpful, but I have a few questions.

    So, what exactly do you mean when a bounce is breaking? Does breaking mean it WAS high, but now low or now the BG numbers are going to start to be "normal"?

    I know a lot of times you can tell if the
    cycle will activate depending on the numbers of +2, but how close for the numbers need to be? For example, PMPS 487 and +2 was 372. Would this be an active cycle?

    Is it only for Lantus, or is it usually on lower preshot numbers?

    Last question: With Lantus you shoot but the amount is determined by the nadir and you need mid day information. I get this is why it's so important to fill in data. But does this mean that the preshots "don't matter" so much because it won't kick in till later?
     
  27. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    May 30, 2010
    Looks like Grey is having a bit of a bounce from the blue numbers last night. It’s great you got some PM numbers. If you can continue to do so as others suggested, it will give you more data to determine whether more insulin is needed. As+2 and before bed works great; if he’s dropping, you’ll need to test a bit more.

    A bounce is when the liver and pancreas excrete counterregulatory hormones and glucagon to raise the BG, for safety, after numbers have dropped quickly or gone lower than the liver is accustomed to. Bounces can last up to six cycles and when the BG starts to come back down, we call it “clearing” or “breaking” the bounce, Bounce clearing cycles can be extremely active with numbers coming down quickly again.

    TuffyKitty is on PZ. The information about onsetting at +2 applies to Lantus. With Lantus, if the +2 is the same or less than the preshot, we say it can be an active cycle. Meter variance in a specific meter is 20% so that can help you decide if numbers are similar or not.

    With Lantus and Levemir, we dose based on the nadir and hold doses according to whether the Tight Regulation Protocol or Start Low Go Slow is being followed. Preshots should be considered when we shoot but we are primarily shooting for what the nadir will be.

    Experienced members here generally shoot every number above 50 as long as they have supplies and are available and able to test. This might be different with PZ so check with the experienced members in the PZ forum. It’s important to take into account with the PS whether it is a dropping number and how fast it’s dropping or whether it’s the second dip that Lantus is known for.
     
    Mphair84 likes this.
  28. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

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    Dec 31, 2009
    The preshot helps you determine if bg is headed up, or headed down-important to know, particularly when faced with a PS lower than you are accostomed to shooting.
     
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  29. kurikitty

    kurikitty Member

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    Jan 28, 2019
    So mon-fri I work 8am to 5pm. I come home at 10am during my first break and give him his am shot. Then I give him his pm shot just before bed at 10pm. I've gotten his numbers at 8 and 9 pm, are these good times to test? His numbers have been really high all day.
     
  30. kurikitty

    kurikitty Member

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    Jan 28, 2019
    He's such a sweet boy. <3
     

    Attached Files:

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  31. Bear & Lora

    Bear & Lora Well-Known Member

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    With your schedule after work I would do a +8, +10 and preshot test, then the next day +9, +11 and preshot test.
    Plus one before you go to bed test.
    Those tests will fill in a little more of how Grey reacts toward the later part of his cycle.

    Has anyone mentioned checking for ketones?

    Bear also has higher numbers when he bounces.
     
  32. Bear & Lora

    Bear & Lora Well-Known Member

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    When you have a chance you should take the ? prefix off.
    You can do that by using Thread Tools, which is under the search engine.
     
  33. kurikitty

    kurikitty Member

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    Jan 28, 2019
    Done.

    Ok so if we give him his shot at 10:15pm and sleep at 11, I should still test again before bed?
     
  34. Bear & Lora

    Bear & Lora Well-Known Member

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    Sep 24, 2018
    No, you need to test him at +2 or +3 after the onset of Lantus to determine if he will have safe BG because a lot of cats have lower BG at night.
     
  35. Bear & Lora

    Bear & Lora Well-Known Member

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    Your 10/10 schedule is difficult for the PM.
    I would set an alarm and get a +5 then go back to bed as long as he is not to low.
     
  36. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    You might want to consider changing your shot schedule to something like 6/6....I know getting up at 6am isn't what most people want to do if you don't have to, but by changing, you'd be able to get a +2 every morning before you leave, and easily get at least a +2 and before bed at night.
     
  37. Crista & Ming

    Crista & Ming Well-Known Member

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    Jun 10, 2018
    I get up at 6 am, do the cat things, then go right back to sleep.

    The PM shot sometimes poses an issue but I just try to schedule my events after 6:30 pm. If I have a dinner, I can come back around 9 to 10 pm and still get a +3 or +4. Better than nothing. You can also leave more food out if you think you might be late coming home to test.

    I also have family members that can shoot for me if I can't so that's very helpful.
     
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  38. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    That's what I did too….I got to the point where it was so routine, I could do it without ever truly waking up!!
     
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  39. kurikitty

    kurikitty Member

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    Jan 28, 2019
    I tried that schedule at first, it just won't work for me at this moment.

    I can do any kind of testing i need to on weekends, but would that be enough?

    And on my 10 10 schedule, when would be good times to test him?
     
  40. kurikitty

    kurikitty Member

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    Jan 28, 2019
    Sorry for all the questions. It's a lot to take in and I'm still not sure how I am supposed to figure out how to get his numbers in a good place.
     
  41. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    First of all, relax.....Grey didn't get diabetes overnight and you're not going to cure him overnight either. It was months before I started seeing any kind of pattern with China. Some cats are lucky enough to go into remission quickly, but the vast majority will be insulin dependent for life.

    If possible, you want to get at least 1 mid-cycle test on the AM cycle (not always possible if you work full time and can't get away for lunch or something) but if that's the case, it's even more important to get tests on the PM cycle.....always at least a +2 or +3 because most cats go lower at night, and if the +2/+3 is a lot lower than the PMPS, you will need to set an alarm to get more tests in to keep him safe.

    During the week, if you work, try to get tests before you walk out the door and/or as you walk in the door. Any test is a good test and adds to the data!!

    There's some information on "Can I do Tight Regulation with a full time job" that has some good tips in it for working people. Even if you're not doing TR,there are some good ideas.

    On days off and weekends, do at least 1 curve and get some random tests in at other times on the other cycles.
     
    Bron and Sheba (GA) likes this.
  42. kurikitty

    kurikitty Member

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    Jan 28, 2019
    Ok, thank you!
     

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