DOSING QUESTION - 1st low reading below 200

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Missy & Tammy, Jan 1, 2021.

  1. Missy & Tammy

    Missy & Tammy Well-Known Member

    Joined:
    Dec 8, 2020
    Hi There,

    I am still learning how all works so please forgive me if I haven't quite figured it all out yet. I am learning as I go along.

    For the first time since Missy started insulin (Dec 30th) I have now seen a number below 200. Her Nadir today at +6 was 113. I gave her a little bit of Fancy Feast Pate (her usual food now) and retested 30 min later and it was up to 126. I was trying to avoid a hypo situation.

    At +7 she was 140. With 5 hours left to go before insulin again I am trying to figure out what to do. I think I have decided to go SLGS protocol. I am inexperienced with all of this and don't like taking chances with things so important as this at least not at this time.

    From what I understand I now have to dose her based on her Nadir of 113. Is this correct? I have no idea what to decrease from. She is on 1 unit of Lantus. I have attached her spreadsheet for review.

    Thank you all for your help, Happy New Year!

    https://docs.google.com/spreadsheets/d/1sgWxkHF6R86hUW6LoiE0DFK4z_cPBblCVKY2JNDR0N8/edit?usp=sharing
     
  2. Hercule's mum

    Hercule's mum Well-Known Member

    Joined:
    Jul 27, 2020
    Hi Tammy,

    I am a newby myself, so not giving you dosing advice per se...
    However, knowing how anxious I get when I have a shot coming up and being unsure... I thought I would point out that SLGS, suggest holding a dose for 7 days unless reading go below 90, which I think it has not happened. So following protocol, you would hold the dose. It is wonderful and nerve wracking as the treatment start working and you see low numbers.....

    Hopefully someone else with more experience with Lantus will come along to reassure you.
     
  3. Butters & Lyla

    Butters & Lyla Well-Known Member

    Joined:
    May 30, 2020
    Hi. It's great to see that 113! And so soon after starting. It looks like the Missy is really working the juice!!:cool: So you've decided on SLGS. Great. You can always change to TR later if you want to.

    A lot can happen with Missy's BG numbers between now and PMPS, so try not to worry too much right now. My suggestion is that if her PMPS is lower than usual, please post here for help and stall without feeding Missy. Edit your title to include the "?" prefix, and add "Stalling, Low PMPS Help Please" or something like that. Someone will help you decide what to do. And nobody will encourage you to shoot without first making sure that you have lots of test strips, can stay up to monitor Missy, and that you have higher carb foods and syrup. Safety first.

    While SLGS calls for shooting any number 90 and above, you're new and don't have much data. So just in case no one is around to help you, here are the guidelines on handling a lower than normal preshot number from the SLGS Dosing Sticky that you, as a newer member without much data could use.

    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.
     
    Ilianna and Socrates likes this.
  4. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    Hi. With SLGS you hold the dose for a week unless she drops under 90. If that happens she earns a reduction. If she’s around 200 at PMPS give the same dose tonight. If under 200, stall, don’t feed and ask for dosing advice in your title.
     
    Last edited: Jan 2, 2021
  5. Missy & Tammy

    Missy & Tammy Well-Known Member

    Joined:
    Dec 8, 2020
    Thank you everyone for your responses. I will make a post closer to dosing time and hopefully some people can help me determine which route to take.
    Her BG is starting to creep up again. +9 it was 192; +11 (more like + 10.75) was 225.

    I will test in one hour (6:45pm PST) and post results question. Thanks again :)
     
  6. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    Since she is on the way up you won’t change the dose tonight. So shoot 1.0. Get the pmps and then test at +2.
     
    Butters & Lyla likes this.
  7. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Nice job today managing MIssy's cycle! Are you still testing for ketones?

    FWIW, you can delete the rows on your spreadsheet prior to when you started collecting data.
     
  8. Missy & Tammy

    Missy & Tammy Well-Known Member

    Joined:
    Dec 8, 2020
    I just posted a few hours ago and do not know how to edit yet so my message gets seen right away.

    Missy has been on 1 unit Lantus/12 hours since Dec 30th.

    Today was her 3rd day of insulin. At +6 she was 113. I do not know for sure what I dose her for PMPS as I do not have a lot of data to make a decision by. I am planning on trying to follow SLGS protocol and I know it says to hold dose for 7 days.

    I do not want to make the wrong decision seeing her Nadir today was 113 at +6. Her PMPS just now was 255. Is it safe to give her regular dose of 1 unit?

    I just took her also took her BLOOD ketones NOT urine and they were 2.6

    She has NOT had any food for at least 2 hours.


    ** Just for some history on ketones. She was in emergency on Dec 30th because her BLOOD ketones were 5.7. After urine analysis they showed NO acidosis even at 5.7.

    I have attached spreadsheet for review.

    Thank you all so much for helping and guiding me through this.


    https://docs.google.com/spreadsheets/d/1sgWxkHF6R86hUW6LoiE0DFK4z_cPBblCVKY2JNDR0N8/edit?usp=sharing
     
  9. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    As I said in your other post her dose tonight is 1.0. This is the 6th cycle. With TR you hold the dose for a minimum of 6 cycles. With TR the earliest you would increase would be tomorrow morning. If following SLGS you would hold this dose for 7 days. Given her history I would follow TR.
     
    Bandit's Mom likes this.
  10. Missy & Tammy

    Missy & Tammy Well-Known Member

    Joined:
    Dec 8, 2020
    Thank you for your help. I'm sorry to keep being a pest I just really am trying to make the best most informed decision I can. Thank you again.
     
    Bandit's Mom likes this.
  11. Bandit's Mom

    Bandit's Mom Well-Known Member

    Joined:
    Oct 18, 2019
    Hi Tammy, you do not need to attach her spreadsheet with every post. It is linked in your Signature. We do ask that members link their previous post in their latest post so that we can look at history.

    The link to your previous post:
    https://www.felinediabetes.com/FDMB/threads/dosing-question-1st-low-reading-below-200.240857/
    https://www.felinediabetes.com/FDMB/threads/advice-please.240816/

    I agree with Elise, that TR will get you to Missy's optimal dose quickly and with ketones in the picture, that is what I would do!

    And you are welcome to ask as many questions as you like! :)
     
    tiffmaxee likes this.
  12. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    You are not a pest at all. You are a caring, worried fur mom. We will help you. To change your title do you see thread tools at the top of your condo? Click on it.
    Get a +2 tonight and post the results, okay?
     
    Bandit's Mom and Missy & Tammy like this.
  13. Bandit's Mom

    Bandit's Mom Well-Known Member

    Joined:
    Oct 18, 2019
    Tammy, I've deleted the rows before Dec 30th and also added a column for Ketones.
     
    tiffmaxee likes this.
  14. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Tammy, I've merged your two posts of today. It's better for us helping you if all the action is kept in just one post per day.

    POSTING GUIDELINES PLEASE READ
     
  15. Missy & Tammy

    Missy & Tammy Well-Known Member

    Joined:
    Dec 8, 2020
    This is a big learning curve for me. Thank you for your patience... not just caring for a diabetic cat but also using this forum. Lots to learn, understand and remember. One day at a time :)
     
  16. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    No worries, we were all new once and remember what it's like. :bighug:
     
    Ilianna and Socrates likes this.
  17. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Missy --

    You commented above that despite a high level of ketones, her urinalysis showed no evidence of DKA. DKA is diagnosed by blood tests. Electrolyte levels are off. It's not something that can be assessed by a urinalysis.
     

Share This Page