Skipping insulin dose

Discussion in 'Feline Health - (The Main Forum)' started by Fluffles, Sep 29, 2017.

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  1. Fluffles

    Fluffles Member

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    Sep 23, 2017
    Hi Everyone Is there a suggested BG number/cut off where you should skip a dose of insulin or give a reduced dose to a newly diagnosed cat? Thank you
     
  2. W.K.

    W.K. Member

    Joined:
    Feb 16, 2017
    For a human meter 200 is the cut off, for a pet meter 250. As you collect more data and get to know how Fluffles responds, that number may go much lower. I'm not familiar with Lantus so I don't really know about dose reductions. Maybe @Kris & Teasel may have some advice. You could always post over at the L/L forums. There are lots of eyes there familiar with your insulin.
     
  3. Noah & me (GA)

    Noah & me (GA) Well-Known Member

    Joined:
    Dec 3, 2016
    You'll get more help as the night goes on and more people log on. I'm not a Lantus user. Best wishes, keep on posting.
     
  4. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    From: http://www.felinediabetes.com/FDMB/threads/lantus-levemir-start-low-go-slow-method-slgs.129446/
    How to handle a lower than normal preshot number:

    In the beginning 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 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 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, your goal is to achieve flat numbers that are greater than 90, so there is no need to push a cat into numbers lower than that.
     
    Monica & Josie likes this.
  5. Chris & China

    Chris & China Well-Known Member

    Joined:
    May 10, 2013
    You should move over to the Lantus forum now that you're testing and have your signature/spreadsheet filled out

    You'll get the most experienced people helping you there

    At first, we suggest if you get a Pre-shot under 200, you stall, don't feed and post for help. Test again in 20-30 minutes to see if the number goes up without food (indicating that the last shot is wearing off)

    We have an unwritten "rule" here that if someone offers to watch out for you (when you're shooting a lower number the first few times), that person won't leave you until you're comfortable with how the cycle is going.....Or they'll find someone else with experience to take over.

    When you move to the Lantus forum, that number drops to 150.....then, as you get more data on Fluffles, you learn to shoot lower and lower numbers. Lantus does it's best work when shooting lower numbers. "Shoot low to stay low" is a saying we have.

    Those of us with enough data and experience will shoot anything over 50 (on Tight Regulation)....On SLGS, you work towards shooting anything over 90
     
    tiffmaxee likes this.
  6. Fluffles

    Fluffles Member

    Joined:
    Sep 23, 2017
    Thank you all so much for your help! Lots to learn and so much experience here. This site and all of you are invaluable! I will be sure to check out the lantus page
     
    JanetNJ likes this.
  7. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    You've missed a few days on the spreadsheet.... How are things going?
     
  8. Fluffles

    Fluffles Member

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    Sep 23, 2017
    thank you so much for checking up on us! My monitor that I had stopped working and I wasn't able to get the store get to buy a new due to several things going on here that I won't bore you with, but I ordered the relion and it just arrived today and I tested for the first time. It was 75! so I'm glad it arrived because I would have shot and clearly that could have been an issue. I am skipping the dose tonight and will monitor throughout the night and I'm home tomorrow so I can monitor more closely tomorrow too. Do you think i should stay at 1.5 for a few more days to get some more data or go down to to 1.25 starting tomorrow? Fluffles seems to be feeling so much better and is finally back to acting like himself, full of energy and affectionate, purring and eating well. I'm feeling really optimistic right now! Thanks so much for checking on us, I really, really appreciate it!
     
  9. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    Wow good catch! See what the numbers are in the morning and post on the lantus boards if you are unsure.
     
  10. Fluffles

    Fluffles Member

    Joined:
    Sep 23, 2017
    Oh, yes still learning my way around the site. I will post my lantus questions on that page. I just reread about about dosing and I think I will try to do a curve tomorrow and see where we are at. But still I'm so impressed with this website, the wealth of knowledge and experience here, and the amount of caring that goes on here blows me away! The best thing my vet did for Fluffles and I was to tell us about this site. Just in case no has told you lately , I am very grateful for all of you!
     
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  11. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    That's great that your vet pointed you here! I think doing a curve tomorrow is an excellent idea.
     
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