PMPS = 158

[Melissa and Celle]

I haven't shot this low in a while (and not since learning that it might not be smart). I tested 10 minutes later and got a 171. Was that enough reassurance that it's OK to shoot?

I'm not sure at what point I would NOT shoot. I've read the posting on what to do, but I'm still not so sure. I always test then shoot right when I get up and right when I get home from work, so waiting for her to rise will always mean missing the shot time.

I guess the good news is that we finally after many months have low numbers to worry about again instead of the crazy high ones.

And thanks for the new board! I joined over on the Levemir board and stayed there because I'm not going for tight regulation. I can't handle the stress given how rarely I'm around to keep monitoring over the day to see how she's doing.

 

[Venita]

My guess on 158 to 171 ten minutes later is that the number was on the rise, or at least not falling.

I think shooting 3.25 at 171 was OK. I would have done it. I see that you normally get a +3 or +4 test on the PM cycle, so I guessing you will also be doing that tonight. So that will add info to your "database."

 

[Anonymous]

I agree, when you see the number is clearly on the rise...I feel safe in shooting. As a rule the dose will take about 2 hours to kick in. That is not written in stone. I want to review your SS becuase when you start shooting lower numbers you may also be ready to reduce dose.
Lori

 

[Anonymous]

OK, after a really quick look at that SS I see that there is little if any experience with shooting a blue number and getting any mid-cycles.
I would have been a little leary about shooting the full dose.....but that is me.
It will be interesting to see your +'s and I will be checking on you k?
Lori

 

[Melissa and Celle]

+4 = 264. Does this help tell me what to do next time? Is there a number below which I shouldn't shoot? I feel fairly comfortable shooting lower numbers because of how often I did it before without any problems (even though I know now I shouldn't have done that).

 

[Anonymous]

Melissa I don't think you necessarily have to skip a shot with your blue numbers....you have room to reduce your dose.
I think it's likely the number went up with too much insulin on board.
Me? I don't know your story very well...but with a sudden low number like that I would have taken a unit off the dose.

 

[Blue]

Melissa,
I have a 2-number rule I use when wondering if safe to shoot... I have one cat, Oliver, whose nadir is around ps, so you never know if he is still dropping or on the rise.

If in doubt with my ps test number, I test again in 15min and then in another 15min. If the 2 extra numbers are both rising, I am fairly safe to think that Oliver's on the rise.

Another thing you could do is to test before ps around +11.5 and then ps would confirm which direction the numbers are going and at what speed.

Just remember to hold back the food when doing any of the testing to be sure none of your numbers are food influenced.

 

[Venita]

+4 = 264. Does this help tell me what to do next time? Is there a number below which I shouldn't shoot? I feel fairly comfortable shooting lower numbers because of how often I did it before without any problems (even though I know now I shouldn't have done that).

Tonight's numbers tell me that you can more than safely shoot a full dose at a mid-blue (mid-100s) number. But because this is only the 3rd cycle on 3.5U, that "rule" may not hold in a few cycles when the Lantus "shed" is completely full. But it could also be that you are finally breaking through insulin toxicity and see fewer pink/red values and more blue/green values. This will be interesting to watch.

As for a number below which you should shoot...setting a shoot/no shoot line is for you to set based on your comfort level based on past data and current circumstances. I know some people who will not shoot below 100, regardless of the type of insulin. I have seen others with cats on Lantus shoot into a low 40s number. (I wouldn't shoot any cat in the 40s, and I cringe when I see it done, but that's me.) Right now you know you likely have a safe shoot/no shoot line of 160 for a 3.5U dose under current circumstances. Except for the very new, I have never thought of the shoot/no shoot line as being stagnant, but rather something you should reevaluate whenever you have additional data to support the reevaluation. (Was that wishy-washy enough for you? ohmygod_smile)

Gayle said

Just remember to hold back the food when doing any of the testing to be sure none of your numbers are food influenced.

I completely understand that "rule," but it doesn't necessarily have to be a rule you apply in "Relaxed" Lantus. Some cats, like my Ennis, live to eat, and food-withholding fools are not something he suffers gladly. He eats what he needs to eat every 2-3 hours. In his case, it is my opinion that no BG number is more food-affected than another. Even if a cat were fed every 6 hours (4 times/day), and the times were fairly consistent from day to day, I would say that again, you have a pattern that is equally affected by food and that can be relied upon.

Ennis doesn't like it when he sees a cat hungry just for the sake of getting a lower PS number, and I don't really either.

 

[Melissa and Celle]

Thanks for all the help! AMPS was 347 this morning, so blues may indeed be abnormal, but I guess it is good to know they shouldn't worry me so much.

 

[Blue]

I completely understand that "rule," but it doesn't necessarily have to be a rule you apply in "Relaxed" Lantus. Some cats, like my Ennis, live to eat, and food-withholding fools are not something he suffers gladly. He eats what he needs to eat every 2-3 hours. In his case, it is my opinion that no BG number is more food-affected than another. Even if a cat were fed every 6 hours (4 times/day), and the times were fairly consistent from day to day, I would say that again, you have a pattern that is equally affected by food and that can be relied upon.

Ennis doesn't like it when he sees a cat hungry just for the sake of getting a lower PS number, and I don't really either.

the rule to see 2 rising numbers is meaningful because if you tested a cat frequently, every 30min, you would see lots if zig zag, so if you test and get a number that makes you pause, the 2 rising numbers is a method to help reassure yourself.

As for the other suggestion of 'no food for 2hrs prior to ps', it is not done to get a low ps number, but rather to get a TRUE ps number. We all know that food causes a spike to BG and humans often will use R or something to counteract that spike, so if you feed the cat, get a safe number, shoot normal dose, then food wears off in an hour or two, and you have a cat that got too much insulin for the true PS value.

Imagine if you feed at +11 and an hour later you test the cat, get a 175, then shoot a normal dose thinking all is well. If you tested again at +1 or +2, you may find that the fed cat is down to 120 as the food has worn off and the nadir is yet to come.

I would think for safety of the cat and a relaxing of the amount of testing, keeping food up for 2hrs prior to ps is a good way to ensure your ps test is pure. There is nothing to stop you from giving a small low carb treat like a piece of FD chicken or something or even some steamed or raw chicken piece.

 

[Venita]

Ennis tells me he can get behind the idea of a plate of raw chicken up to two hours before test time. In fact, he lives for raw chicken and thinks that is a splendid idea.

Me: "But, Ennis, Auntie Gayle didn't say a PLATE of raw chicken. She said a PIECE of raw chicken."

Ennis: "Then Auntie Gayle just doesn't understand us, Mom."

OK Ennis. OK Ennis. I will transcribe for you.

I continue to differ, Auntie Gayle. I understand where you is at, but in my "food *****" world, if food is given all the time at +10 or +11, because some cats want to eat as soon as the bean rises from da bed or gets home from work, dat "food spike" always will have been part of the data that has fed (no pun intended) into the dosing equation. Now, if dosing has been based on the food spikey PS number, and you are saying that that makes a curve look more bouncy than it would if the food spikey number was at +2, so be it. The curve is still consistent and safe, to my furbrained way of thinking.

Now, iz another thing if the history iz not based on consistent feeding at +10 or +11. Yep, then things will be wonky, and da bean needs to take dat into consideration. But my fellow cats tries to make sure dat we get gets fed consistently. We iz creatures of habit, and when our stomachs scream for food, we listens.

Well there you have it, from the mouth of my one and only food-***** Ennis.

 

[Melissa and Celle]

As for the other suggestion of 'no food for 2hrs prior to ps', it is not done to get a low ps number, but rather to get a TRUE ps number. We all know that food causes a spike to BG and humans often will use R or something to counteract that spike, so if you feed the cat, get a safe number, shoot normal dose, then food wears off in an hour or two, and you have a cat that got too much insulin for the true PS value.

This sort of makes me despair of ever getting things right. Celle free feeds, and I shoot when I wake up and when I get home, so there isn't a way to know if she's eaten beforehand. Most of the time, I think she has. When I'm around during the day, she seems to get hungry around +10-12 and eats.

I have 3 cats, so the amount of food eaten in a cycle varies quite a bit, and I never know even how much Celle in particular had. If I try to measure the food so she runs out before +10, she may in fact run out much earlier when she really might need it.

So what do pre-shot values really mean then? Or any values, really?

Food can't fully explain the erratic values that we get either. When she was on dry Purina DM, she ate the exact same amount at the exact same time every day, and we still saw numbers all over the place.

 

[Wendy & Tiger]

This sort of makes me despair of ever getting things right. Celle free feeds, and I shoot when I wake up and when I get home, so there isn't a way to know if she's eaten beforehand. Most of the time, I think she has. When I'm around during the day, she seems to get hungry around +10-12 and eats.

Don't despair!

I understand the logic for not feeding before a PS test. In an ideal, meal-fed world that would be great.

But reality is sometimes different... Like dear Ennis, who wants to eat NOW when he's hungry... Or when you are dealing with a herd - when one eats, everyone eats - and they do NOT appreciate waiting... Or when they free-feed 24/7 - like Celle, & my Tiger (& the rest of my herd) did...

When Tiger got a PS that was lower than I was comfortable with I went ahead and fed (everyone). I often tested her at about +10/11 because she tended to have a late nadir (or a double-dip nadir). If I had a +10/11 number that would help show if she was already going up (so OK to shoot) or not. If I didn't have a late number, or was still not comfortable, I'd test again after another hour. But knowing she had just eaten, I would want to see a significant increase before I shot. Going from 100 to 110 wasn't enough - that's basically the same number (within normal meter variance). But if she went from 100 to 125+ then I felt comfortable that she was on the way up.