On Lantus - BG results erratic - advice please?

Hi there, Jack is still newly diagnosed so we are nowhere near regulation. We have switched him to Lantus (Glargine) 4 days ago. Started on 2 units (he responded very quickly and BG results were low) so reduced to one unit. My vet said if he tested under 12 mmol/L (216 mg/dL) to not give any insulin (it's Christmas time and was not available so we decided to err on the side of caution - better to have higher readings than low), so for the last 2 nights at I have given none.
This morning Jack was "HI" (over 33.3 mmol/L (599 mg/dL) I decided to give him 0.5 units, thinking he might be a little more "even" on this dose.
Vet not open yet.

Would apprciate any thoughts - I am a novice!

 

Hi Merrin

Good to see you've changed to better juice! It looks like your vet is going down the same path ours did when we moved to Lantus. She was dosing Lantus like caninsulin. Thing is, Lantus needs consistency in dosage and timing. The insulins are so different.

Caninsulin is an insulin that is administered the used by the body in one cycle.
Lantus is a depot insulin that builds up in body and is dispensed over time.

Here is some info on Lantus and how it works
http://felinediabetes.com/FDMB/threads/sticky-lantus-levemir-what-is-the-insulin-depot.150/

Have you had a look at the tight regulation protocol for using Lantus? It shows you how to dose, increase and decrease based on nadir (the lowest point in the insulin cycle)
http://felinediabetes.com/FDMB/threads/sticky-lantus-levemir-tight-regulation-protocol.1581/

This is the doctor Rand protocol (your vet may like this information to read?). http://www.felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf

If it were me, I would decrease the dose to .5u BID and hold it for 6 cycles to see how it goes. If you can, don't alter the dose.

Read this sticky on low numbers and how to handle. If you were worried,past a conversation on the Lantus board with a title that shows you're concerned to shoot.

And lastly, get yourself kitted out with a hypo kit. some high carb food (fancy feast gravy lovers is perfect) and a bottle of glucose syrup (baking isle in the supermarket) and keep plenty of strips on hand. You can buy then cheaper in NZ from the caresens.co.nz web shop. We go for 5 boxes a time to keep the overall cost down to aroun 15.50 per box of 50.

I hope this helps! Fire away with any questions

Charlene

 

http://felinediabetes.com/FDMB/threads/sticky-lantus-levemir-shooting-handling-low-numbers.147/

Forgot to give you the low numbers link!

 

Thanks Charlene That is all great information. I will keep him on 0.50 units for now and monitor his BG. Taking a good look at the tight regulation..

 

Sounds like a plan!

 

Hi

Just wanted to pop in and say that you have been given some great information by Charlene. My cat remi was diagnosed in September of this year and after a brief stint on caninsulin switched to lantus. I started him on a 0.5 of a unit twice a day and followed advice I got on here about when and how much to increase. Soon enough we had got his blood glucose under good control.

Best wishes

Sarah

 

28 Dec 2014 - ADVICE NEEDED

thanks, do you have any advice this morning - am unsure whether or not to shoot 0.5 units

My intention was to go with 0.5 units for 6 cycles BUT..

Jack tested 6.2 mmol/L (111 mg/dL) this morning should I shoot 0.5 or reduce to 0.25?

scared of sending him too low

 

I am not experienced enough to advice. How long till shot time? They often advise stalling for 15 minutes with no food to see if the numbers go up. In the meantime I will flag your need for advice on another forum.

Have put a request for advice on the lantus forum.

 

28 Dec 2014 - ADVICE NEEDED

due for shot 10 minutes ago. Thanks, I am unsure of how to flag posts for immediate attention.

 

The best thing is to edit the title and put exactly what you need but the forum has just changed over to a new version and I am not 100% sure how to do that just now.

Hopefully someone will be along soon. But in the meantime don't feed and retest in 10 minutes and post up new results.

 

28 Dec 2014 - ADVICE NEEDED

due for shot 8am
8am tested 6.2 mmol/L (111 mg/dL)
8:15 am re-tested 6.5 mmol/L (117 mg/dL)

 

Have you got any more test results from during the day? Ie do you know what the +4,5 or +6 results were as lantus is dosed on the lowest a cat goes not necessarily the preshot numbers.

To confirm are you just dosing lantus once a day? Or do you mean 8 am and 8.15 pm

 

shooting twice a day. This is the morning's results only. 8:15am is a re-test. So it looks like he is going up not down (perhaps?)
I didn't test overnight

 

Can you retest him now?

 

28 Dec 2014 - ADVICE NEEDED

due for shot 8am
8am tested 6.2 mmol/L (111 mg/dL)
8:15 am re-tested 6.5 mmol/L (117 mg/dL)
8:30 am re-tested 6.6 mmol/L (118.8 mg/dL)

so slowly going up

 

I just replied in your other thread. The main concern would be that you can't monitor him and you don't have enough data to be able to predict what he will do plus the lantus is still building up.

 

Dyana has also replied in your other thread.

 

that's good advice - I still don't fully have my head around how the Lantus builds up. I am ingesting as much information as I can trying to keep up! Erring on the side of caution seems the best thing. It's a little frustrating as I would like to keep him on one dose for a while to try and get a picture of how he is responding - it's all so erratic right now

 

Print out those links and read them over and over again. You will soon get the swing of it. lantus likes consistency but at the beginning it can take some time to get things settled.

 

Have you read dyana advice? What have you decided to do?

 

I agree if you aren't going to be home today, then skipping is the safest thing to do, as you don't have enough data. It will come, it's just not there yet. Your kitty will probably be high by tonight, but we don't go by the Pre-Shot test to determine the dose. Maybe you can start over again with the 0.25 dose and see if you can shoot that dose twice a day. Just a thought.

 

I meant maybe you can start over again tonight with the 0.25 dose.

 

Thanks Dyana and phlika29! Yes skipping this dose. It did occur to me also to start again at 0.25 units tonight. He seems to be very responsive to Lantus and if like you say it builds up maybe a lower dose will help so I can get into a routine dose for a spell.

 

The decision has been made. Feed your Jack. Remember, he may be really high tonight. Just give him the new dose and let's see if you can be more consistant on 0.25 twice a day. You can always increase the dose later.
See if you can get 6 cycles (3 days) on the same dose. And get some night time tests, if you can, please

 

Thanks I will try for night time tests too Really appreciate the support

 

Hey Merrin

Just popping on to say have a wonderful day and with a suggestion re getting data ready.

As you get time, you might like to pop in some overnight tests such as a pmps +1 and + 2. A lot of cats have lower cycles at night to add to all the other mischief they get up to! This will help you become data ready for both cycles

Take it easy today! It's all very overwhelming at first

Charlene

 

Thanks Charlene, let's see how he goes on 0.25 units. Hopefully I can be accurate with the syringes, measuring 0.5 seemed a bit hit and miss!

Shouldn't be a problem getting a few night time tests - the little blighter is in and out of my bedroom all night now I leave the door and one eye open like a new mother! I love him to bits though

 

They don't call them fur babies for nothing right? Last night I heard Java's feeder turn for his snack meal, and I got up to make sure he noticed too! He hadn't so I helped him with the noticing!

The things we do

 

love it!