? Help starting on Lantus

[Tom B]

Max was diagnosed last week. Until I could find Lantus (thank you again @Donna and Flame) for a reasonable price, I started Max on Novalin N. For the few days he was on the Novalin, his numbers would drastically dive and then climb back up, but it was quite predictable.

Today is our first day on Lantus. His AMPS was 304, +1 329, +3 280, +6 245, +9 247, then his PMPS was 237. I gave him his shot (1u) because I didn't see any large drops throughout the day and I really didn't know what to do.

1. Should I be testing more frequently? I don't want to turn his ear into a pin cushion...
2. Is it normal to have the PMPS be the lowest reading of the day?
3. Should I have given him the shot/skipped/or delayed?
4. Do I wait the 5-7 days using the SLGS method or should I consider upping the dose since he isn't even getting lower than 200's?

I don't want to be too aggressive with the dosing because my wife and I are going away in two weeks. My brother will be looking after Max and I need to make it as easy as possible for him. I don't know how cooperative Max will be. Would you suggest maintaining a lower dose that yields numbers in the 200-300 range but has a very low risk of Max going hypo, or follow the SLGS potentially upping his dose each week until we leave?


Thanks in advance,
Tom

 

[Chris/China (GA)/Garfield]

Do I wait the 5-7 days using the SLGS method or should I consider upping the dose since he isn't even getting lower than 200's?

Answering these a little out of order....You want to hold the dose for 5-7 days no matter what....Unless he drops below 50 on a human meter, 68 on a pet meter (could you add what kind of meter you're using to your signature?...looks like you're using a human meter from your spreadsheet).

Lantus is a "depot" insulin.....it takes that long to "fill the depot"....think of it like this...when you first start, some of the insulin goes to work and the rest goes "in the depot" and is slowly released back into the bloodstream.....but until the depot is "full", it's not going to release the correct amount

Should I have given him the shot/skipped/or delayed?

You should have given the shot.....Here, if you get a Pre-shot under 150, we want you to stall, don't feed and post for help. Retest in 20-30 minutes to see if he's coming up on his own without food...that's a pretty good sign that the last shot is wearing off and it's safe to shoot. When you first shoot a lower number, we like to have someone with experience watching out for you, so make sure your subject line says something like "STALLING, NEED HELP!" to get someone's attention (you can go back and change it later)

Is it normal to have the PMPS be the lowest reading of the day?

At this point, there is no "normal".....it will take time for that depot to fill and start seeing something that even closely resembles normal.....for us, it was about 4 months before China's numbers started to have any pattern

Should I be testing more frequently? I don't want to turn his ear into a pin cushion...

You want to always test before shooting to make sure he's high enough for insulin at all....after that, if at all possible, get at least 1 mid-cycle on the AM cycle and on the PM cycle, get a "before bed" test.....most cats go lower at night, so that "before bed" test is really important.

If you can get more tests in, great....but it's not absolutely necessary unless he's dropping too low and you need to keep an eye on him.

A little Neosporin with pain relief ointment (not cream) can really help heal those little pokies! Just a tiny bit will help a lot....and his ears will "learn to bleed" too.....the more you poke, the more new capillaries grow in and the easier it'll be to get blood. I think I could just look hard at China's ears and they'd bleed!

 

[Wendy&Neko]

Hello and welcome to you and Max.

Answering these a little out of order....You want to hold the dose for 5-7 days no matter what....Unless he drops below 50 on a human meter, 68 on a pet meter

Small correction - the magic number is 90 since you are using SLGS. If you wish, when you and your wife get back, you can decide then if you wish to move to Tight Regulation. Totally up to you and what fits your lifestyle.

Here, if you get a Pre-shot under 150, we want you to stall, don't feed and post for help. Retest in 20-30 minutes to see if he's coming up on his own without food..

That's what we suggest for people following TR. For SLGS, when you are new, the number to pause is 200, or if a number is way below what you expected. Since you don't have any data yet, we don't know what "expected" will be. It was fine to shoot that 237 tonight. Just get a test before you go to bed, to make sure it's safe to go to sleep. It's suggested to a little more testing at the beginning, as some cats have strong initial reactions to insulin. And that data might help you learn the following concepts about Max on Lantus:

• Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
• Peak/Nadir - the lowest point in the cycle
• Duration - the length of time insulin continues to lower blood glucose

Once you've got these figured out for Max, it'll help you determine the best times to test, in additon to the preshot tests.