? Dora 7/15/20 PMPS 171

Hi, I feel as if Dora is responding better to her insulin lately. I’ve been holding her at a steady 1.25 (tried going to to 1.50 because she wasn’t falling low enough but she immediately dropped so went back down) but now we are starting to have to skip shots. Following SLGS I see with 171 I’m in a place where I make a choice. Last time I gave a “token dose” she didn’t respond. Not sure if I should skip tonight or give her less, maybe 0.5? I can’t count on myself to check her in the night although can of course test at +3 which is about bedtime.

We didn’t do a midday test today due to workers in the house.

I have about 15 minutes so will probably just go with the token dose if no time for replies. Thanks very much !

last thread: https://www.felinediabetes.com/FDMB/threads/dora-6-26-2020-pmps-178.231562/

 

dora, where did your glasses go?
i can't give help on the dose, but if you use the "?" prefix in your title, you'll likely get more eyes on.

 

Thanks! Updated but it’s go time!

 

Stalling is always an option if you can afford to get off schedule.

 

thanks. How is that beneficial, other than pushing it back? Trying to understand the concept of stalling, would this indicate maybe we are coming due for a dose reduction? Or is it better to just stall or skip? I really like keeping her on schedule. Last week we were out late and she peed all over the leather couch! I know she did it because I tested and she was positive for sugar! (No ketones...)

 

Stalling just shows you if the numbers are coming up. Lantus takes about 2 hours to begin working so usually the numbers are coming up before the insulin has had a chance to take effect. If you can't afford to get off schedule than stalling might not be an option. If there is any history of ketones skipping isn't a good option either.

 

Being on SLGS I think you reduce if Dora drops below 90.
The board is kinda slow this evening. Hopefully some other peeps will come along and offer more advice.

 

Copied from the SLGS how to handle lower than normal pre shot #s:

How to handle a lower than normal preshot number:

Until you collect enough data to know how your cat will react, 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, Basaglar, 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 kitty's 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, generally speaking, your goal is to achieve flat numbers that are greater than 90 mg/dL. However, let experience, data collected, knowledge of your cat, and availability to monitor help in making the best decisions for your cat.

If kitty is dropping faster or lower than you'd like, please see "Don't Panic! or How to Handle Low Numbers" and post for help or suggestions.

 

If this were my cat, I would stall, don't feed and test again in 20-30 minutes....if the number goes up, that's a pretty good indication that the last shot is wearing off and it's OK to go ahead and shoot the scheduled dose.

The way all this is "supposed" to work is that you shoot the same dose both AM and PM and our cats "Earn" reductions by dropping below certain points (SLGS is below 90) Hopefully, they keep earning reductions all the way down to zero insulin at all!

If you never shoot those lower preshots, your cat's much less likely to ever earn those reductions and therefore less likely to ever get into remission.

You can make up a 30 minute stall the next day so it doesn't throw you very much off schedule. You can either shoot 15 minutes early in the AM and PM tomorrow or shoot 30 minutes early on the PM the next day and you're right back where you were

 

It is important for you to get at least a "before bed" test on every PM cycle. Most cats go lower at night, so it's important for safety to make sure they're not dropping too quickly before you call it a night.

Yes, there will be some nights where you will need to set alarms to get up and check (or just stay up) but that's what you need to do to keep your cat safe as well as give them the best chance at remission.

I know it sounds scary when you see that 1 unit can drop Dora from 300 to 150....so if you gave 1 unit at 150, she'd drop to zero!!!.....It doesn't work that way. Take a look at China's spreadsheet (now we did TR but the concept is the same). Giving Lantus at those lower preshots usually just levels out the cycle...instead of dropping 150 points, they only drop 40 (for example)

A perfect Lantus cycle is almost a flat line instead of a "curve" like you see with some other insulins and when you first start treatment.

Maybe set yourself a PS that's a little lower than your current comfort level and try to get past your fear and go ahead and shoot (especially if it's on a cycle where you don't have to leave or get up early the next day). The way to gain confidence is to just do it.

As long as you can test and have all the stuff you need in your "hypo kit", YOU are always in charge of your cat's blood glucose.