? When not to give insulin

Hi Everyone - I just did a PMPS test and it was 141. I seem to recall that there is a # where I should not shoot. Is it below 200?

Thanks!
Patti + Jett

 

1. This is from the sticky on handling low numbers.
   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.

 

Usually, once you're testing successfully and keeping your spreadsheet up to date, we drop it to 150 here, but that doesn't mean "no shot".....it means you should stall, don't feed and test again in 20-30 minutes and see if they're coming up on their own yet

As you gain more experience, that "no shot" number starts to come down even more.....those of us with enough data on our cats will shoot anything over 50

 

Thank you, Chris and Tiff. Max and China are beautiful kitties! I searched high and low for this information and must have been looking past it. I did shoot and am watching him closely.

I really appreciate your help!
Patti

 

If you can, it would be good to get a +2 test. That test is usually a good indicator of how the cycle will go. If it's the same or lower than PMPS, you may have to do some more monitoring tonight.

 

Thank you, Wendy! I just did a +2 test and it's 85. I fed him treats (no carb) and his wet food (4% carb). I am concerned about being able to test frequently in the middle of the night. Should I give him a few kibbles of dry food (30% carb)? I have had a really bad day with my husband's cancer issues, so I'm beyond exhausted and dehydrated from crying all day. Any ideas what I can do to mitigate any hypo issues while I am asleep?

Thanks!
Patti + Jett

 

With Max if I fed him a little lc or mc often he was more likely not to go low. You can leave from old put as they usually will eat if they go low. I'm so sorry about your husband. My mom was in and out of the hospital when Max was diagnosed so I know how stressful it is. She's home at this point but on hospice with heart failure. You have a very stressful situation so you may need to keep Jett a little higher so yiu can handle everything. Knowing that I was the bling of says don't shoot which is why I didn't give advice. It would be a good idea for you to get an auto feeder. You can set them to go off every few hours and that way you can make sure there is fresh food out.

 

That's a pretty significant drop for so early in the cycle.....If you gave him some low carb food at +2, I'd test him again at +2.5 and see if he's still dropping

 

I'd make sure he has lots of food around to snack on if you can't test him tonight. Perhaps even medium or higher carb food. Do you have high carb wet food around? If not, you can add a drop or two of karo, honey or syrup to his regular low carb food. That +2 is a big drop which means an active cycle and he'll probably go lower tonight without food intervention.

I see you went with 2 units tonight - that was smart. In fact, I think I'd continue with 2 units tomorrow onwards. Although your signature does not say, I'm assuming that with your circumstances and limited ability to test, you are following the SLGS method for dosing. With SLGS, any number under 90 earns a .25 unit reduction.

ETA: Elise's suggestion of getting an autofeeder is a good one if he's not a grazer. You could set it up to give him fresh food every hour for the first part of the cycle if you think he's going low.

 

Thank you, Wendy, Chris, and Tiff! Jett made it through the night and his AMPS test was 90, so I didn't give him a shot. I hope that is the right thing to do. I will try to test him again before we leave the house at 12:30pm for my husband's radiation treatment. I am so excited that his BG is back in normal range. I am nervous about not knowing his low #!

 

I just checked out the labs. Looks like Jett has CKD and "might" have had pancreatitis when he was tested. The Presision PSL is elevated. Max's was too but he has chronic pancreatitis. This is a new test and my vet is not so sure if it's reliable. The above normal ALT is another signal and Max has this happen too with pancreatitis. If his appetite tanks it would likely be the cause and a nausea medication like ondansetron would help. The thyroid is low but could be just fine and be normal next time. I'd only be worried at this if he's in medication for hyper-t and I don't see that listed. Looks to me like a reduction is needed but see what others say.

 

Good call not shooting today when you can't monitor. It will be interesting to see what his mid day test is after skipping. He definitely needs less insulin. Good to read those SS remarks on him playing last night.

 

Well, Jett's good numbers didn't last I only gave 2 units, since I had the lower #s and reduced it previously. I didn't know if I should stick with the dose decrease or not.

 

Thank you, Tiff. Jett had a severe ear infection when these labs were done. I think the infection contributes to many of the elevated #s, especially the BG #, and I agree with your concerns about CKD. I do suspect pancreatitis, but the vet said we would need to do an ultrasound to determine pancreatitis. We agreed to do an ultrasound just a few months ago, so I'm not inclined to do another one right now. I was hoping the normal #s were going to stick, but tonight's #s were frightening!! I only shot 2 units, since I had decreased the previous shot to 2 units. I have no idea if that was the right thing to do or not.

Thanks!

Patti + Jett

 

You missed a dose, plus he's probably bouncing from the greens that earned him a dose reduction, hence the temporary high numbers. We don't know how low he went last night, but it was low enough to earn that reduction to 2.0 units. We know that 2.25 units is too much insulin. Try to ignore the higher numbers. Bounces can take up to 6 cycles to resolve and the skip will have impacted the depot. I bet you'll wake up to a much lower number tomorrow morning.

 

I agree, bouncing can be really frustrating until you can figure out what they are! There is a good description that helped me understand them in the first Welcome..start here sticky.