? Need help with shooting with lower number

I don't know what is going on but yesterday Pooper's has been going up all day with eating FF and the 5.5 units he got in the morning at around his normal time. Last night before I went to bed he went from 406 to 295 in +3 hours and this morning brace yourselves he was at 156!!!!!! He has not been that low with a morning number since December. What the heck is going on with him? I am not doing anything different other then giving him the 5.5 units of insulin. So my question is, since he is under 200, I didn't give him any insulin. If I have to give him any, what amount do I give him? I was leaning towards .5 to 1 unit. If not then I was just going to let it go an hour and then retest and if he is above 200 then give him 1 unit?? What do you guys think I should do?

Update: He tested at 236 10 mins ago from the 156 that he was at around 830 this morning. I won't be here today to keep an eye on him so that is why I didn't give him a shot especially if I am supposed to give 5.5 units like I have been doing. Afraid of him dropping too low when I am not here to check him. What do I do?

 

link to other thread in main forum

 

Just read through your other post. As others have said, Lantus needs consistency to work well so if you are able to get some testing in over the weekend hopefully Pooper keeps producing the lower numbers.
If you ever want Pooper to have a chance at regulation or remission you will eventually need to get comfortable shooting 200, 100s, [removed TR protocol information]
This is good progress to see Pooper making!

 

On this board, we use 150 as the post and ask for help number. For experienced users, most of us will shoot any number above 50. As Melanie pointed out, you need to start to wrap your thinking around getting comfortable with shooting progressively lower numbers. Ditto that you need to think in terms of shooting the same dose. Every time you reduce the dose for one cycle, your count for when it's time to increase Pooper's dose starts over. You need 5 - 7 days at a consistent dose in order to increase when following SLGS.

 

So your saying if he is under 150 regardless I give him the same dosing? I would think if he is under 200 and if I gave him 5.5 units he would really to dangerous levels.

 

Drops are not going to be as steep in the lower numbers as in the higher numbers. Often cats will go pretty much sideways once you start shooting numbers under 100. You do need to get enough tests to know what your cat is doing, no one will ever suggest shooting blindly into lower numbers. Yes, it takes a little bit to get used to the idea of shooting the lower numbers. But if you pull back the dose every time Pooper makes progress and starts getting into the lower numbers, then Pooper can't make progress can he?

Every shot is a learning opportunity. Since you had a furrshot today, now you can learn what happens when you skip a shot (or have a really reduced amount since some may have gotten in). If you opt to do a reduced shot, you find out how that affects his numbers. When you can monitor and shoot the full dose on a new low for Pooper, you will be able to find out how he does on getting a full dose on those numbers. As you gather that information you will become more confident in understanding what is going on inside Pooper.

If you look at our foster Sly's spread we have skipped 2 shots recently, one because we couldn't monitor shooting a new low and last night because he just had such a low day. Those two skips have told us Sly doesn't handle skips well and we need to find a way to not let him go without insulin for 24hrs. The information we get from every test, every decision helps us make better decisions going forward.

 

Is there a "no shoot" number for SLGS, and would it be adjusted up or down based on how "data ready" a caregiver might be?

And is there a "you would NEVER shoot below this number" no matter what for SLGS?

 

Not only will no one suggest you shoot low blindly, we strongly recommend that you become "data ready." As you are learning more and more about how Pooper responds, you are collecting data. If you look at the beginning of Gabby's SS (back 5 yrs ago), her patterns are very different than they are now. While there are always exceptions, I can pretty well predict where her numbers are heading. If you look at the Shooting & Handling Low Numbers sticky, there's a section on becoming data ready.

 

Carl:
I don't know if there's a "no shoot" number for SLGS. This might be a question for Jill since she is more familiar with that approach. I suspect that like with any approach, you build toward shooting progressively lower numbers.

 

As hard as it is to wrap your head around this, that's not the way that Lantus and Levemir work. If you start at lower numbers, the cycles tend to be a lot flatter. With Neko, I love shooting the 80's because a lot of times she'll stay in the 80's the entire cycle. But I only learned that with lots of data gathering.

And just because I know Carl loves wrapping his head around high dose cats - we have a number of cats here with high dose conditions that have shot a lot more than 5.5 units into much lower preshot numbers. Cats need the amount of insulin they need. Caregivers with high dose cats got to that dose by increasing according to the protocols/methods to make sure they aren't over dose.

Stalling (as you did), without feeding, to wait for the numbers to rise to a level you are comfortable shooting is a technique many will use when faced with lower numbers than they are used to. You just don't want to stall too long because the next shot is 12 hours after that.

 

High doses don't phase me anymore.
All I was trying to point out is -
The caregiver isn't data-ready.
He is following SLGS.
Somebody needs to draw a line in the sand for "no shoot".
And a " NEVER" shoot number would be a nice thing to know.

If I were the only bean on the board and saw the original question, my response would be "if the number is under 200 and you aren't going to be home to monitor today, put the insulin back in the fridge and have a nice day".

 

I haven't chimed in on this for several reasons... mostly because I have to literally post and run.

• The OP is using the SLGS approach which means everyone offering suggestions/advice has to turn off their TR brains!

• The reduction earning point for SLGS is 90.

• The never shoot under number for SLGS is 90.

• The " Shooting & Handling Low Numbers sticky" does NOT apply to SLGS and says so in red at the top of that sticky.

• INITIALLY (with SLGS), the no shoot number is for anything under 200 (the typical no shoot number on the board). With SLGS, you want to gradually lower your no shoot number based on the data you've collected and the individual caregiver's comfort level. In other words, gradually lower the no shoot number using the data you've collected to support your decision. It's a gradual and methodical process based on the caregiver's availability and comfort level.

Circumstances which should have been factored into advice given today:

• caregiver is using SLGS method
• the current dose has not been reached in the manner we're accustomed to: small increments & consistent dosing (look at Poopers ss).
• the caregiver will not be around to monitor closely
• the caregiver is brand new to Lantus use and his data doesn't support much of anything at this point.

I've probably forgotten some good points. I'll add them when I get home if I happen to think of any. I guess the best advice I can give those who are offering advice to members following SLGS is to turn your TR brain off before replying. Believe me, I know how hard that is!

 

Thats what my thoughts were on the whole insulin shooting. I knew I wouldn't be home this afternoon to monitor him so I didn't want to give his 5.5 units if he was at 156 and worry he'd drop well below 100 in the afternoon and I wouldn't be there to look. I guess the one thing that doesn't make sense is this... When he is in the 300-400s and I give him his 5.5 units he drops atleast 2oo points. So if he was somewhere under 200 and I gave him his usual dose, wouldn't that fricken kill him? I can relate to reduce dose because of that and for him to get insulin and that is why I was thinking of just 1 unit of insulin this morning so he was getting insulin instead of skipping. I just don't understand why so many say to don't skip and give insulin because if you don't give the regular dosage then it will mess his numbers up if the depot runs out but I'd be worried he would go hypo in a bad way.

 

But I retested him an hour after his preshot number and noticed it was rising so that is why I gave him a reduced shot although it was a fur shot. However, whatever it is tonight probably will be high to give him his 5.5 units. Then will have to see tomorrow morning what his numbers are. He has a very weird body to go from having rising numbers yesterday using the same protocol on him to having a nice mid 200s last night and then the 100s this morning. Not sure what changed other then the dosing might be what his body was looking for and staying with it.

 

As much as that makes perfect sense, that's just not how Lantus works

Lantus works BEST when it doesn't have to pull down those high numbers....when you start at a lower number, the cycle can be much more "flat"....so even at high doses, once you have the necessary data, you can safely shoot those lower numbers and instead of seeing a big swing, just see a gentle curve.

As you go forward, you'll gradually shoot lower and lower numbers....once you've got enough data to show it's safe to do so. Most of us will shoot the scheduled dose if they're over 50 at Pre-shot, but only after having a lot of tests under our belt and really understanding how Lantus works...and there are still times we might skip if we're unable to test during the cycle even after that

Since you're using the SLGS method, you'd not shoot if his preshot below 90 ever though

 

Ryan is following SLGS. With SLGS, 90 is the cut-off... the lowest number one would ever shoot.

 

I had just edited to add that Jill

You beat me to it

 

I honestly think those who have very strong experience and know what they are saying and know what protocol that I am following should be helping me with this. No offense and I greatly appreciate all the help but I don't like seeing different solutions to what I need to do when the end is I do not want to harm my boy. I am learning about this as well when I don't come on here but I'd rather get answers from the more experienced people who have had treated diabetic cats for a long time. Thanks!

 

Couple things with this though...
It's almost impossible for newer members to have a good idea of who "knows" or has lots of experience with the insulin, or the protocol. Being here a long time doesn't make someone an "expert". Actually, nobody here should be referred to, or should consider themselves "an expert". We're all lay people who have, or have had, diabetic cats. "Number of posts" can sometimes indicate who has been here long, or who might be more experienced. But take me for instance. I have zero experience with Lantus. I did not follow either the TR or the SLGS protocol. Sure, I have a boat load of "posts" under my name. But that doesn't mean diddly about my level of experience, expertise, or knowledge. It just means I talk a lot (or used to anyway).

And you will never find one or two people who have all the answers. Nobody here does. And hoping for or expecting one solution instead of multiple solutions or multiple opinions on how to proceed? That is never going to happen for any caregiver asking for help or advice. Because there isn't and never will be "one way to do this".

I've been on the board for almost four years. There are people posting here currently who have been here for four weeks that know more than I will ever know about using Lantus. You yourself do. In that four year period, I actually used insulin for less than four months. My "experience" level is minimal. Most of what I know, I've learned from others.

But you should not rely only on those you think are the most experienced. First off, they might not be around when you post a question, and sometimes you need a quick answer. All you can do is read the input from everyone, and try to figure out what you can or can't "use" out of what you read. Don't sell anyone short. Plenty of people who have relatively little experience can help you learn too. Every person who posts here has something to offer, and everyone who posts here can "teach" you, me, and any other member who reads these threads something. Anyone who thinks that they "know it all" is deluding themselves. There isn't a person in the world that can't teach me something I don't know.

Carl

 

Carl's points are well taken. We all do our best to provide some guidance. The additional problem is that several of the questions that Carl raised are not in the SLGS sticky note so there is no consistent reference, which is why I suggested that Carl contact Jill. I would reiterate that while the Shooting & Handling Low Numbers sticky is largely geared to the TR Protocol, the section on becoming data ready may be helpful for you to look over.

Regardless of which protocol you follow or where your "no shoot" number is, the idea that the magnitude of a drop is consistent regardless of a dose isn't how Lantus or Lev work. You may get a clearer sense of this if you look at several spreadsheets. You'll be able to get a sense of what happens when you encounter higher or lower numbers at pre-shot times.

 

Sorry for the hijack...

@Sienne and Gabby - revising the Start Low Go Slow sticky was a group effort, and I imagine additional discussion would be welcome. Feel free to post your suggestions here: Proposed adjustment to Start Low Go Slow protocol. I remember some things were intentionally left vague because with SLGS, it is even more important to consider the caregiver's limitations and tailor advice to the specific situation. You wouldn't necessarily want someone who tests only once or twice a day to say "this says I can shoot at 90 so it's ok." The board's default is 200 and that's a better spot for new folks to start, IMHO. 90 would be something to work toward if the caregiver can collect data to support that recommendation.

I know when I wrote the "Shooting Low Numbers" post for Tight Regulation, I didn't even want to sticky it because I didn't want random people to stumble across it and think they could safely shoot a 50. I would feel the same way about a blanket statement saying shooting at 90 was ok.

 

@Libby and Lucy: Thanks for the info. I didn't know about the Think Tank thread.