What is the absolute no-shoot BG pre-shot number?

Hello everyone,

One week after I completely removed dry food from Nathan's diet, his BG has dropped a lot. Now his pre-shot numbers are 120-150.

I have been trying to find the optimal dose for him. In the last few days, I have tried 0.1u and 0.15u, and found the following:

If he eats a big meal (2.5-3oz canned food) at the shot time, then 0.1u is not enough (just like doing nothing), but 0.15u will bring his numbers down to 70-80.

If he eats a smaller meal (1-1.5oz canned food) at the shot time (this usually happens at PM shot time because sometime he eats too much at AM+8 so he is not very hungry at the PM shot time), then 0.15u is too much for him and will drop his BG too fast and too low. So in this case I just shoot him 0.1u, or maybe even less, depending on how much he eats.

This 0.1u/0.15u dose strategy based on the food intake has worked well for the pre-shot BG 120-150.

However, this morning his AMPS was 100 and my husband is not home in the daytime so I cannot test him, then I just skipped the morning shot.

I read somebody's reply to other's post before that as the owner gets more experience/data, they may be able to shoot over 90, but I am not very sure about this number and couldn't find that post/reply.

Would somebody please clarify the no-shoot number or give me a link so I read?

Thanks a lot.

 

I’m not a prozync expert so I’m tagging @Deb & Wink did you look around in the prozync forum?

 

I re-read the post in the modified prozinc method. It mentions the PSs above 50, though I really doubt if a cat needs insulin when PS is a bit over 50.

I thought I read somewhere else and the the number was 90, but maybe my memory is faulty.

http://www.felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/


How to handle a low pre-shot number:

• Sometimes your kitty will surprise you with a lower than normal PS number (but above 50). When that happens you have four choices:
  • Skip the dose: If the number is below 200, and your kitty is newly diagnosed (less than three months), your best option is to skip unless your kitty has ketones or is post-DKA (see below) and you should post here or in the Health Forum for help.
  • As you gain more experience and data, your goal is to gradually learn to shoot lower and lower numbers (never below 50). You can use other options below as you are learning to shoot below 200. Ultimately, with data, experience, and knowing your cat, you should be able to shoot PSs above 50 provided you are available and able to monitor.

 

90 is on the SLGS protocol and 50 on TR

 

The TR protocol is more aggressive so you’d still be shooting to lower numbers than on SLGS method. It’s about what you’re comfortable with and it sounds like you prefer the later

 

Yes I prefer the BG 90 of the SLGS protocol.

I am just curious if a cat needs insulin on BG a bit over 50 even in the TR protocol.

50 (even on a human meter) is considered low BG, right?

 

The 90 and the 50 BG levels that are mentioned, are the nadirs or lows, where you would intervene with food to bring the cat's BG levels back up. You do not want to go lower than those numbers, depending on which Prozinc protocol you are using.
The Prozinc SLGS protocol uses 90 as a nadir for a dose reduction.
The Prozinc MPM (Modified Prozinc Method, equivalent to lantus TR protocol with some tweaks for prozinc) uses 50 as a nadir for a dose reduction.

If you have a LOT of data, know very well how your cat reacts to the different carb levels of food (LC, MC, HC) AND the insulin, AND are around to monitor AND have plenty of test strips AND your hypo tool kit, then shooting a 50 pre-shot BG would be ok if you are using the MPM protocol. Same conditions hold with shooting a pre-shot BG of 90 if you are using the SLGS protocol, meaning you have a LOT of data, know VERY well how your cat reacts to the different carb levels of food (LC, MC, HC) AND the insulin, AND you are around to monitor AND have plenty of test strips AND your hypo tool kit fully stocked.

Otherwise, you use the stall method to see if the BG's are rising or skip the shot.

Liang, you don't have enough data to shoot a pre-shot of 50.

The section that Liang quoted, back in post #3, on shooting a lower than normal pre-shot, is specific to the MPM Prozinc protocol. There are 2 sections to the Prozinc dosing protocol document. Be sure you are referring to the correct section when you are reviewing it for guidance.

One reason that Nathan's BG levels are going to be higher at PMPS is because you are feeding him at +8. You should limit food after +6. Do you think you could do that? Perhaps using a timed feeder, to give Nathan his meals after the pre-shot meal.

A BG of 50 is in normal range for a cat. 50-80 ideally, 50-120 is even considered to be a normal range. Without insulin support. Nathan is getting close to not needing insulin any more, but he isn't quite there yet. The longer that Nathan stays down in those blues and greens at mid-cycle, the more support and rest and recovery time that gives his pancreas. Time for his pancreas to heal and start producing more insulin on it's own.

 

Thank you very much. I just cannot thank you enough for your help.

I don't think I will shoot a pre-shot BG of 50, not even shoot a pre-shot BG of 90.

To me 50-90 are normal BG levels, so I am curious why people would shoot at these levels.

What I wanted to ask in my post is that, at which pre-shot BG level should I absolutely skip the shot now? Is it the 90?

Nathan's full dose now is 0.25u if his pre-shot level is >200.

However, in the last few days, his pre-shot levels have been 100-160, and never up to 200. So I didn't use the stall method. I just give him a token dose directly (0.1u-0.15u, depending on how much he eats at the shot time). Is it ok? Or should I still need to follow the stall-test-shoot/skip method?

I will try not to feed him after +6. I can change the feeding schedule by combining the +4 feeding and the +8 feeding to the +6 feeding.

How do I know it is time that Nathan does not need insulin any more?

Thanks again.

 

Because there are some cats getting a lot more insulin than Nathan is getting, and they need to keep their cat's BG levels on track.

Because if they or you totally stop the insulin, the BG levels will rise too much, leading to more insulin being needed.
Those are only 2 of the reasons why people give their cat insulin when the cat is in "normal" BG numbers. Normal does not mean in remission. Normal does not mean that the insulin can be stopped.

I still think it's a good idea for you to stall and retest and make sure the BG level is rising before you give Nathan the shot. Especially if he is closer to the lower range that you quoted, closer to the 100-130 range.

 

Thank you so much. I will follow the stall method tonight and see if his BG will rise.

The reason that I didn't follow the stall method in the past week was that, from 06/05/2020-06/08/2020 each time when I got a <200 PMPS number I stalled without feeding, but his BG didn't rise. So I thought it was Nathan's situation, so I just gave him the token dose.

But now I will stall and retest to see if he shows otherwise.

 

If you look at China's spreadsheet, you'll see I gave insulin with her in normal numbers because I learned if I didn't, her blood glucose would skyrocket and then I'd have to go to higher doses to get her back down again.

Now we used Lantus, but the theory is still good. You start by giving the scheduled dose when they're close to 200 and then test enough to learn how your cat responds.....as you gather more experience and data, you lower it to where you'll shoot at (for example) 180...then 160....140...etc. etc.

 

How do I know when it is time that Nathan doesn't need insulin? @Deb & Wink

Today his pre-shot numbers were <100. We stalled 30 minutes and re-tested, and his BG was not rising. But I still gave him a micro dose (0.1u) to keep his BG a bit lower in the mid-cycle.

The 0.1u is the lowest dose I can draw.

I read the post of "proper handling and drawing", and it says there is a lower dose than 0.1u which is a "droplet".

But each time after I inject the 0.1u dose, I check the syringe and there is always some residual insulin, which is about the size of the "droplet". So I wonder even though I can draw the "droplet" dose, it may not go into Nathan's body actually.

 

Here is something I wrote up some time ago, about drop dosing.

Drop Dosing

How many drops do you get from your insulin syringes if you draw the liquid up to the first line? Not the first line with a number next to it, or the shorter line that shows half unit markings. The very first line on the syringe. What we think of as the zero mark.

• Practice, practice, practice to see how many drops you can get out of the syringe.
• Use some sort of colored clear juice like apple juice or colored water.
• Mark the syringe well. Painter's tape, duct tape, masking tape at the top of your “practice syringe”. So you don't forget and use that syringe to draw up insulin.
• Draw the "test liquid" up to the first line on the syringe.
• After you have drawn up a tiny bit of “test liquid”, point the needle up towards the ceiling and give the syringe a "finger flick. To move/push the air bubbles to the top of the syringe. Push out the air bubbles.
• Slowly “twist” the syringe plunger to push out all the “test liquid.”
• Then when one small drop of “test liquid” is all that is left on the beveled tip end of the needle, draw the syringe plunger back to "suck" that 1 drop back into the syringe.
• You are looking for consistency.
• Try to get evenly sized drops.
• Practice, practice, practice until you get a consistent number of drops.

Do you think you have the technique down for the drop dose?

Then let me know.

When it’s for real. You’ve practiced and are ready to give a tiny “1 drop” dose.

Draw up a tiny bit of insulin, needle pointed up to the ceiling and give the syringe a "finger flick”. To move/push the air bubbles to the top of the syringe.

• Push out the air bubbles that have floated to the top.
• Slowly “twist” the syringe plunger to push out all the insulin.
• Then when one small drop is all that is left on the beveled tip end of the needle, draw the syringe plunger back to "suck" that 1 drop back into the syringe.

"Finger flick” technique - make a circle with thumb and first 2 fingers tucked into first thumb joint. Quickly “snap” those first 2 fingers against the syringe barrel held in your other hand. That will force any air bubbles up to the top of the syringe. Then you can push the air bubble out.

Syringes have a lubricant inside. Before you draw up insulin, moving the syringe plunger up and down a couple of times helps the plunger move more easily.

Give the shot. Monitor.

Later, if you need to, you could increase the number of drops.

Be aware that some syringes can vary on where the lines are on the barrel.

When you stop the insulin and Nathan's BG levels stay in the normal range, the greens, <99 but preferably <80, for 14 days straight. With perhaps a "blip" here and there to a higher number.

 

Thank you very much for the information.

I will practice and see if I can draw the drop dose successfully.

 

Nathan may be getting ready for an OTJ trial.

 

Thank you. I will stop shooting him if his pre-shot level is <90 and see what happens.